Introduction: Diabetes mellitus has been associated with an increased risk of adverse outcome after coronary artery bypass graft surgery. HbA1c is a reliable measure of long-term glucose control. It is unknown whether adequacy of diabetic control, measured by hemoglobin A1c, is a predictor of adverse outcomes after coronary artery bypass grafting. The predictive role of HbA1c on short term outcomes after coronary artery bypass graft surgery has not been evaluated. Diabetes mellitus has become a major health issue and contributes to morbidity and mortality from coronary artery disease. The purpose of this study is to determine the predictive role of preoperative elevated HbA1c on post-operative outcome in CABG patients. Objectives: This study evaluates the early postoperative outcomes of CABG in terms of mortality and major postoperative morbidities like deep sternal wound infection, sepsis, stroke, renal failure, bleeding, arrhythmia, and mediastinitis in patients with preoperative elevated level of HbA1c. Methods: This prospective study was done in National Institute of Cardiovascular Diseases (NICVD). Patients of coronary artery disease (CAD) with DM referred for CABG were enrolled for the study. Total 60 patients were allocated into two groups. Among them 30 patients with preoperative HbA1c of <7% and another 30 patients with preoperative HbA1c of > 7 % underwent CABG surgery from January, 2009 to December, 2010. The early postoperative outcomes were compared between two groups. Both groups were matched with no significant difference that could influence the postoperative outcome. Results: In-hospital mortality was high in patients with preoperative elevated level of HbA1c. An elevated hemoglobin A1c level predicted in-hospital mortality after CABG surgery. Our study revealed that HbA1c greater than 7 % was associated with increase in mortality. For each unit increase hemoglobin A1c , there was a significantly increase risk of myocardial infarction and deep sternal wound infection. By using receiver operating characteristic value thresholds, renal failure, cerebrovascular accident and deep sternal wound infection occurred more commonly in patients with elevated hemoglobin A1c. Morbidity, infections and the composite outcomes occurred more commonly in patients with elevated HbA1c. Conclusion: Elevated HbA1c is strongly associated with adverse events after coronary artery bypass graft surgery. Preoperative HbA1c measurement may allow for more accurate risk stratification in patients undergoing coronary artery bypass graft surgery. Bangladesh Heart Journal 2019; 34(2) : 92-99

Background: Coronary artery bypass surgery (CABG) with cardioplegia has been considered the gold standard operation for coronary revascularization. Activation of compliments system after CABG surgery involves C-reactive protein (CRP). Patients with preoperative increased CRP levels have significantly higher CRP levels on postoperative days and are at increased risk of developing postoperative complications. High sensitivity CRP ( hs-CRP ) is lower concentration of CRP measured by the hs-CRP test. It is more sensitive and more useful in predicting the potential risk level for cardiovascular disease, heart attacks and strokes. Objective: To assess the association of preoperative hs-CRP level with the incidence of postoperative arrhythmia, low output syndrome and sternal wound infection following on pump CABG surgery. Materials & Methods: The study was cross sectional analytical study. A total of 70 patients were selected. For the purpose of analysis the study subjects were divided into two group; Group A patients with preoperative hs-CRP level <3mg/l (n=35) and Group B patients with preoperative hs-CRP level >3mg/l (n=35). The incidence of early outcome- arrhythmia, low output syndrome and sternal wound infection were observed within 30 days of surgical procedure. Results: The incidence of arrhythmia, low output syndrome and sternal wound infection were significantly less in group A than those in group B. Logistic regression analysis showing significant correlation of hs-CRP with arrhythmia, p value is 0.005; with low output syndrome, p value is 0.003 and with sternal wound infection, p value is 0.004. Conclusion: Preoperative hs- CRP is an important determinant of post operative outcome after CABG surgery and might be useful as predictive marker in risk stratification for postoperative complications in patients scheduled for on pump CABG surgery. KYAMC Journal Vol. 9, No.-4, January 2019, Page 153-158

Introduction: The Mean Platelet Volume (MPV) is a marker of platelet size with increased platelet activation. An elevated MPV is associated with major cardiac adverse events after Coronary Artery Bypass Graft (CABG) surgery. Effect of preoperative MPV on outcome of in-hospital patients after coronary artery bypass graft surgery was investigated in this study. Objective: To investigate the association of preoperative MPV with in-hospital outcome of patients after CABG surgery. Materials and Methods: An observational prospective study was carried out in the Department of Cardiovascular Surgery, National Institute of Cardiovascular Diseases (NICVD), Dhaka during the period from July 2012 to June 2014. Preoperative mean platelet volume was obtained prospectively in 81 consecutive patients undergoing conventional coronary artery bypass surgery. The patients were divided into two groups according to normal and elevated MPV at 10.60 femtolitre (fL) cut off level. Postoperative mortality and major adverse events were recorded in the early postoperative period. Results: Combined adverse events including post operative Myocardial Infarction (MI), arrhythmia, bleeding and death occurred in 27 patients (33.3%) during the early follow-up. The preoperative mean platelet volume levels were found to be associated with postoperative adverse events (p<0.05). In multivariate logistic regression models, the preoperative mean platelet volume levels was found strong independent predictor of combined adverse events after surgery (OR 1.968, p=0.008). Conclusion: Mean platelet volume is simple, readily available and cost effective tool and useful in predicting the postoperative adverse events in patients undergoing coronary artery bypass graft surgery. Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 53-56

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Background information of the country. Lo cated in the South East Asia region (SEAR), Bangladesh has an estimated population of 124.7 million in 1998 [1] with an annual growth rate of lower than 2% giving a population density of 850 inhabitants per Sq.Km.