Background The optimal glycemic control level in diabetic patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (On-Pump) remains unclear. Therefore, this study aimed to investigate the effect of different blood glucose control levels and glucose fluctuations on in-hospital adverse outcomes in diabetic patients undergoing on-pump CABG. Method A total of 3918 patients with diabetes undergoing CABG were reviewed in this study. A total of 1638 patients were eligible for inclusion and were categorized into strict, moderate and liberal glucose control groups based on post-operative mean blood glucose control levels of  < 7.8 mmol/L, from 7.8 to 9.9 mmol/L and ≥ 10.0 mmoL/L, respectively. The primary endpoint was defined as a composite endpoint including in-hospital all-cause mortality and major cardiovascular complications. The secondary endpoint was defined as major cardiovascular complications including acute myocardial infarction, strokes and acute kidney injuries. To determine the associations between blood glucose fluctuations and adverse outcomes, patients with different glycemic control levels were further divided into subgroups according to whether the largest amplitude of glycemic excursion (LAGE) was ≥ 4.4 mmol/L or not. Results A total of 126 (7.7%) patients had a composite endpoint. Compared with moderate control, strict glucose control was associated with an increased risk of the primary endpoint (adjusted OR = 2.22, 95% CI 1.18–4.15, p = 0.01) and the secondary endpoint (adjusted OR = 1.95, 95% CI 1.01–3.77, p = 0.049). Furthermore, LAGE ≥ 4.4 mmol/L was significantly associated with the primary endpoint (adjusted OR = 1.67, 95% CI 1.12–2.50, p = 0.01) and the secondary endpoint (adjusted OR = 1.75, 95% CI 1.17–2.62, p = 0.01),respectively. Patients with LAGE ≥ 4.4 mmol/L had significantly higher rates of the composite endpoint and major vascular complications in both the strict-control (the primary endpoint, 66.7% vs 12.4%, p = 0.034, the secondary endpoint, 66.7% vs 10.3%, p = 0.03) and moderate-control groups (the primary endpoint, 10.2% vs 6.0%, p = 0.03, the secondary endpoint, 10.2% vs 5.8%, p = 0.02). Conclusions After On-Pump CABG patients with diabetes, strict glucose control (< 7.8 mmol/L) and relatively large glucose fluctuations (LAGE ≥ 4.4 mmol/L) were independently associated with in-hospital adverse outcomes.

Background The purpose of this study was to investigate risk factors of in‐hospital mortality and vascular complications after coronary artery bypass grafting (CABG), particularly the effect of different glycemic control levels on outcomes in patients with and without previous evidence of diabetes. Methods A total of 8682 patients with and without previous diabetes undergoing CABG were categorized into strict, moderate, and liberal glucose control groups according to their mean blood glucose control level <7.8 mmol/L, 7.8 to 10.0 mmol/L, and ≥10.0 mmoL/L after in‐hospital CABG. Results The patients with previous diabetes had higher rates of in‐hospital mortality (1.3% vs 0.4%, P < .001) and major complications (7.0% vs 4.8%, P < .001) than those without diabetes. Current diabetes was significantly associated with a higher risk of in‐hospital mortality (odds ratio [OR] = 3.14, 95% confidence interval [CI] 1.87‐5.27) and major complications (OR = 1.49, 95% CI 1.24‐1.80), and smoking and higher low‐density lipoprotein cholesterol (LDL‐C) levels showed similar results. Among patients with previous diabetes, strict glucose control was significantly associated with an increased risk of in‐hospital mortality (OR = 8.32, 95% CI 3.95‐17.51) compared with moderate glucose control. Nevertheless, among non‐previous diabetic patients with stress hyperglycemia, strict glucose control led to a lower risk of major complications (OR = 0.71, 95% CI 0.52‐0.98). Conclusions Diabetes status, smoking, and LDL‐C levels were modifiable risk factors of both in‐hospital mortality and major complications after CABG. Strict glucose control was associated with an increased risk of in‐hospital mortality among patients with diabetes, whereas it reduced the risk of major complications among non‐previous diabetic patients.

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Purpose Many older patients with acute myocardial infarction (AMI) have impaired ability for activities of daily living (ADL). Impaired ADL leads to poor prognosis in elderly patients. The Global Registry of Acute Coronary Events (GRACE) score is widely used for risk stratification in AMI patients but does not consider physical performance, which is an important prognosis predictor for older adults. This study assessed whether the Barthel Index (BI) score combine the GRACE score would achieve improved one-year mortality prediction in older AMI patients. Patients and Methods This single-center retrospective study included 688 AMI patients aged ≥65 years who were divided into an impaired ADL group (BI ≤60, n = 102) and a normal ADL group (BI >60, n = 586) based on BI scores at discharge. The participants were followed up for one year. Cox survival models were constructed for BI score, GRACE score, and BI score combined GRACE score for one-year mortality prediction. Results Patients had a mean age of 76.29 ± 7.42 years, and 399 were men (58%). A lower BI score was associated with more years of hypertension and diabetes, less revascularization, longer hospital stays, and higher one-year mortality after discharge. Multivariable Cox regression analysis identified BI as a significant risk factor for one-year mortality in older AMI patients (HR 0.977, 95% CI, 0.963–0.992, P = 0.002). BI (0.774, 95% CI: 0.731–0.818) and GRACE (0.758, 95% CI: 0.704–0.812) scores had similar predictive power, but their combination outperformed either score alone (0.810, 95% CI: 0.770–0.851). Conclusion BI at discharge is a significant risk factor for one-year mortality in older AMI patients, which can be better predicted by the combination of BI and GRACE scores.

Two cases were hospitalized in our hospital at the same period. Case 1 was a 40-year-old woman who presented with a 2-year history of episodes of high blood pressure associated with severe headache, pallor in appearance, and cold sweating. The high blood pressure episodes occurred within 1 to 2 minutes after urination, at which time her blood pressure shot up to 180/120 mm Hg. They only lasted for a few minutes and then relieved spontaneously. However, she complained of a 1-month history of aggressive symptoms before admission. Her father had a history of hypertension. On physical examination, her blood pressure was 130/80 mm Hg, with a heart rate of 70 bpm. Other systemic examinations were normal. The urinalysis, electrocardiography and echocardiography tests were normal. Case 2 was a 50year-old man with a 10-year history of episodic hypertension, and his symptoms also appeared 1 to 2 minutes after urination, especially after the first-morning urine. His blood pressure was slightly higher than case 1 at 200-250/100-120 mm Hg, and his symptoms lasted for a few seconds to 5 minutes. However, strikingly, he was very nervous and scared of urination. In terms of physical examination, we found that he was slightly overweight with a blood pressure of 146/68 mm Hg. Echocardiography examination revealed a thickened interventricular septum of 13 mm and left ventricular diastolic dysfunction. In summary, our patients both had remarkable postmicturition symptoms, including paroxysmal hypertension, severe headache, palpitation, and sweating. However, their symptoms only lasted a few minutes and recovered spontaneously. What possible diagnoses and further examinations would you suggest?