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Updated: Aug 13, 2026
Human Internal Mammary Artery IMA Transplantation and Stenting: A Human Model to Study the Development of In-Stent Restenosis
Published on: May 9, 2012
Association of HbA1c and utilization of internal mammary arteries with wound infections in CABG
Tim Knochenhauer1, Andreas Schaefer1, Jens Brickwedel1
1Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Insights
Diabetic patients undergoing coronary artery bypass grafting (CABG) with higher glycated hemoglobin A1C (HbA1c) levels experienced more wound healing disorders (WHD). Bilateral internal mammary artery (BIMA) use increased WHD risk in these patients, but not deep sternal wound infection (DSWI).
Area of Science:
- Cardiovascular Surgery
- Diabetology
- Wound Healing Research
Background:
- Deep sternal wound infection (DSWI) is a significant complication following coronary artery bypass grafting (CABG).
- Diabetic patients undergoing CABG present unique challenges for postoperative recovery and wound healing.
Purpose of the Study:
- To stratify diabetic patients undergoing CABG using bilateral internal mammary artery (BIMA) based on glycated hemoglobin A1C (HbA1c) levels.
- To compare postoperative outcomes, including wound healing disorders (WHD) and DSWI, in relation to HbA1c levels and BIMA utilization.
Main Methods:
- Analysis of 4,186 patients undergoing isolated CABG between 2010 and 2020, with preoperative HbA1c data available for 3,229.
- Stratification of patients based on HbA1c levels (<6.5% vs. ≥6.5%) and subgroup analysis based on BIMA utilization.
- Primary endpoints included WHD, DSWI, and 30-day mortality, with statistical adjustments for confounding factors.
Main Results:
- Patients with HbA1c ≥6.5% had a significantly higher incidence of WHD (5.6%) compared to those with HbA1c <6.5% (2.8%).
- Bilateral internal mammary artery (BIMA) use was associated with increased WHD rates (7.7%) versus no BIMA (3.0%) in patients with HbA1c ≥6.5%.
- No significant differences in DSWI rates were observed between HbA1c groups or with BIMA utilization.
Conclusions:
- While BIMA use is not linked to increased DSWI in diabetic patients, it is associated with higher WHD rates in those with poor glycemic control (HbA1c ≥6.5%).
- Careful consideration of BIMA application is warranted even in diabetic patients with elevated HbA1c.
- Identifying high-risk patient subsets is crucial for preventing DSWI after CABG.
Background:
Deep sternal wound infection (DSWI) remains a serious complication after coronary artery bypass grafting (CABG). We herein aimed to stratify diabetic patients who underwent CABG using bilateral internal mammary artery (BIMA) for levels of glycated hemoglobin A1C (HbA1c) and compare postoperative outcomes.
Methods:
Between January 2010 and August 2020, 4,186 consecutive patients underwent isolated CABG at our center. In 3,229 patients, preoperative HbA1c levels were available. Primary endpoints were wound healing disorder (WHD), DSWI, and 30-day mortality. Patients were stratified according to preoperative HbA1c levels. Patients were further divided into subgroups according to utilization of BIMA.
Results:
After adjustment, no differences in mortality and stroke rates were seen between group 1 (HbA1c < 6.5%) vs. group 2 (HbA1c ≥ 6.5%). WHD was more frequent in group 2 [2.8 vs. 5.6%; adjusted p = 0.002; adjusted odds ratio (OR), 1.853 (1.243-2.711)] but not DSWI [1.0 vs. 1.5%; adjusted p = 0.543; adjusted OR, 1.247 (0.612-2.5409)]. BIMA use showed a higher rate of WHD [no BIMA: 3.0%; BIMA: 7.7%; adjusted p = 0.002; adjusted OR, 4.766 (1.747-13.002)] but not DSWI [no BIMA: 1.1%; BIMA: 1.8%; adjusted p = 0.615; adjusted OR, 1.591 (0.260-9.749)] in patients with HbA1c ≥ 6.5%.
Conclusions:
Intraoperative utilization of BIMA is not connected with an increase of DSWI but higher rates of WHD in patients with poor diabetic status and HbA1c ≥ 6.5%. Therefore, application of BIMA should be taken into consideration even in patients with poor diabetic status, while identification of special subsets of patients who are at particular high risk for DSWI is of paramount importance to prevent this serious complication.
