Hemoglobin A1c in Patients with Diabetes Predict Long-Term Mortality Following Coronary Artery Surgery
Muhammad Abu Tailakh1,2, Shlomo-Yaron Ishay3,4, Jenan Awesat4,5
1Department of Nursing, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel.
Insights
High preoperative hemoglobin A1c (HbA1c) levels in diabetes mellitus (DM) patients undergoing coronary artery bypass grafting (CABG) are linked to increased long-term all-cause mortality (ACM). Maintaining optimal HbA1c before CABG is crucial for better patient outcomes.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Diabetes mellitus (DM) is a significant comorbidity in patients undergoing coronary artery bypass grafting (CABG).
- Preoperative glycemic control, indicated by hemoglobin A1c (HbA1c), may influence long-term outcomes after CABG.
- All-cause mortality (ACM) remains a critical endpoint in post-CABG patient management.
Purpose of the Study:
- To investigate the association between preoperative HbA1c levels (≤7% vs. >7%) and the rate of ACM in DM patients following CABG.
- To assess the long-term mortality risk associated with elevated preoperative HbA1c levels up to a ten-year follow-up period.
Main Methods:
- Retrospective analysis of 579 DM patients undergoing isolated CABG.
- Collection of preoperative HbA1c data measured within 3 months prior to surgery.
- Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression to evaluate ACM rates and associated risk factors.
Main Results:
- Patients with preoperative HbA1c >7% had a significantly higher mortality rate (28.7%) compared to those with HbA1c ≤7% (20.4%) (log-rank p=0.01).
- Multivariable analysis revealed a hazard ratio of 2.67 for long-term ACM in patients with HbA1c >7%, after adjusting for multiple clinical factors (p=0.001).
Conclusions:
- Elevated preoperative HbA1c levels in DM patients undergoing CABG are associated with a substantially increased risk of long-term all-cause mortality.
- Optimizing glycemic control before CABG may be a critical strategy to improve long-term survival and reduce complications in this patient population.
Objective:
to estimate the association between preoperative hemoglobin A1c (HbA1c) levels below and above 7%, and the rate of all-cause mortality (ACM) in diabetes mellitus (DM) patients after coronary artery bypass grafting (CABG) within a ten-year follow-up period.
Methods:
we collected data on patient HbA1c levels that were measured up to 3 months prior to isolated CABG in consecutive patients with DM, and analyzed the rates of ACM over a median of a 5.9-year post-operative period.
Results:
preoperative HbA1c levels were collected in 579 DM patients. The mean HbA1c was 8.0 ± 1.7%, where 206 (35.6%) patients had an HbA1c ≤ 7% and 373 (64.4%) had an HbA1c > 7%. During the follow-up period, mortality rates were 20.4% and 28.7% in the HbA1c ≤ 7% and HbA1c > 7% groups, respectively (Kaplan-Meier estimates, log-rank p = 0.01). Multivariable Cox proportional hazards regression, adjusted for age, gender, smoking status, chronic obstructive pulmonary disease, hypertension, chronic renal failure, old myocardial infarction, number of coronary artery bypass surgeries, and post-operative glycemic control, showed a hazard ratio of 2.67 for long-term ACM (p = 0.001) in patients with HbA1c > 7%.
Conclusions:
DM patients with high HbA1c levels prior to CABG are at higher risk for long-term complications, especially late ACM.
More Related Videos
05:16Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
Published on: June 10, 2025
10:03Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Related Concept Videos
01:15Diabetes: Symptoms, Diagnosis, and Complications
01:30Coronary Artery Disease I: Introduction
01:22Diabetes Mellitus: Type 2 and Gestational
01:20Pathophysiology of Diabetes
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility,...
01:15Diabetes: Management and Pharmacotherapy
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
01:36Carbohydrate Metabolism
Starch accounts for approximately 60% of the carbohydrates consumed by humans. Since amylase enzymes cannot function in the stomach's acidic environment, starch can only be digested in the mouth and small intestine. Simple sugars are found naturally in milk and fruits in...