Increased Glucose Variability Is Associated With Major Adverse Events After Coronary Artery Bypass

Clement, Kathleen C.; Suarez‐Pierre, Alejandro; Sebestyen, Krisztian; Alejo, Diane; DiNatale, Joseph; Whitman, Glenn J.R.; Matthew, Thomas L.; Lawton, Jennifer S.

doi:10.1016/j.athoracsur.2019.06.046

Cited by 23 publications

(19 citation statements)

References 32 publications

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“…Moreover, a post hoc cohort analysis including 160 patients with or without diabetes mellitus showed that post-procedural GV assessed by calculating the mean daily δ blood glucose during the first 2 days after transcatheter aortic valve implantation was associated with an increased risk of macrovascular complications (e.g., death, stroke and myocardial infarction) [44]. Similarly, a retrospective study enrolling 2215 patients who underwent coronary artery bypass grafting reported that increased 24-h but not 12-h postoperative GV was a predictor of major adverse events [45]. Benalia et al revealed that T2DM patients admitted for acute myocardial infarction with elevated GV had significantly higher SYNTAX scores [46].…”

Section: Gv and Diabetic Macrovascular Complicationsmentioning

confidence: 99%

Comprehensive elaboration of glycemic variability in diabetic macrovascular and microvascular complications

Sun

Luo

Zhou

2021

Cardiovasc Diabetol

104

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Diabetes mellitus is the major risk factor for the development of macrovascular and microvascular complications. It is increasingly recognized that glycemic variability (GV), referring to oscillations in blood glucose levels and representing either short-term or long-term GV, is involved in the pathogenesis of diabetic complications and has emerged as a possible independent risk factor for them. In this review, we summarize the metrics and measurement of GV in clinical practice, as well as comprehensively elaborate the role and related mechanisms of GV in diabetic macrovascular and microvascular complications, aiming to provide the mechanism-based therapeutic strategies for clinicians to manage diabetes mellitus.

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Section: Gv and Diabetic Macrovascular Complicationsmentioning

confidence: 99%

Comprehensive elaboration of glycemic variability in diabetic macrovascular and microvascular complications

Sun

Luo

Zhou

2021

Cardiovasc Diabetol

104

View full text Add to dashboard Cite

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“…The brain-blood barrier (BBB) damage has been proposed as a possible cause of POCD [ 5 – 16 ]. Few studies have demonstrated changes of plasmatic and liquor concentrations of Aβ1-42 in patients with POCD, where the postoperative plasmatic concentration was lower and liquor concentration was higher, although the results are contradictory and diverse between the studies [ 8 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Is postoperative cognitive decline after cardiac surgery associated with plasma beta amyloid 1–42 levels?

Požgain

Dulić

Kondža

et al. 2022

J Cardiothorac Surg

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Background Postoperative cognitive decline following cardiac surgery is one of the frequently reported complications affecting postoperative outcome, characterized by impairment of memory or concentration. The aetiology is considered multifactorial and the research conducted so far has presented contradictory results. The proposed mechanisms to explain the cognitive decline associated with cardiac surgery include the neurotoxic accumulation of β-amyloid (Aβ) proteins similar to Alzheimer's disease. The comparison of coronary artery bypass grafting procedures concerning postoperative cognitive decline and plasmatic Aβ1-42 concentrations has not yet been conducted. Methods The research was designed as a controlled clinical study of patients with coronary artery disease undergoing surgical myocardial revascularization with or without the use of a cardiopulmonary bypass machine. All patients completed a battery of neuropsychological tests and plasmatic Aβ1-42 concentrations were collected. Results The neuropsychological test results postoperatively were significantly worse in the cardiopulmonary bypass group and the patients had larger shifts in the Aβ1-42 preoperative and postoperative values than the group in which off-pump coronary artery bypass was performed. Conclusions The conducted research confirmed the earlier suspected association of plasmatic Aβ1-42 concentration to postoperative cognitive decline and the results further showed that there were less changes and lower concentrations in the off-pump coronary artery bypass group, which correlated to less neurocognitive decline. There is a lot of clinical contribution acquired by this research, not only in everyday decision making and using amyloid proteins as biomarkers, but also in the development and application of non-pharmacological and pharmacological neuroprotective strategies.

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“…Reports are conflicting as to whether high preoperative HbA1c is associated with post-operative complications or mortality in patients with DM [ 3 , 7 , 11 , 13 ]. Consistent with our results, a prospective study with a 3.5-year average follow-up by Alserius et al found an 18.9% incidence of mortality with preoperative HbA1c ≥6%, compared to 4.1% in patients with HbA1c <6% [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of poorly-controlled diabetes in CABG patients varies in the literature; research reports 50–80% of DM patients having HbA1c levels exceeding 7%. Moreover, high blood glucose is an independent predictor of cardiovascular disease, regardless of a diagnosis of DM [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Hemoglobin A1c in Patients with Diabetes Predict Long-Term Mortality Following Coronary Artery Surgery

Tailakh

Ishay

Awesat

et al. 2021

JCM

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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.

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Increased Glucose Variability Is Associated With Major Adverse Events After Coronary Artery Bypass

Cited by 23 publications

References 32 publications

Comprehensive elaboration of glycemic variability in diabetic macrovascular and microvascular complications

Comprehensive elaboration of glycemic variability in diabetic macrovascular and microvascular complications

Is postoperative cognitive decline after cardiac surgery associated with plasma beta amyloid 1–42 levels?

Hemoglobin A1c in Patients with Diabetes Predict Long-Term Mortality Following Coronary Artery Surgery

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