Is there a role for HbA1c in predicting mortality and morbidity outcomes after coronary artery bypass graft surgery?: Table 1:

Abstract

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was is there a role for HbA1c in predicting morbidity and mortality outcomes after coronary artery bypass surgery? Eleven studies presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The studies presented analyse the relationship between preoperative HbA1c levels and postoperative outcomes following coronary artery bypass graft (CABG) in diabetic, non-diabetic or mixed patient groups. Four studies found significant increases in early and late mortality at higher HbA1c levels, regardless of a preoperative diagnosis of diabetes. One study demonstrated that 30-day survival outcomes were significantly worse in patients with previously undiagnosed diabetes and elevated HbA1c compared with those with good control [HbA1c >6%; odds ratio 1.53, confidence interval (CI) (1.24-1.91); P = 0.0005]. However, four studies of early mortality outcomes in diabetic patients only showed no significant differences between patients with normal and those with deranged HbA1c levels (P = 0.99). There were mixed reports on morbidity outcomes. Three studies identified a significant increase in infectious complications in patients with poorly controlled HbA1c, two of which were irrespective of previous diabetic status [deep sternal wound infection (P = 0.014); superficial sternal wound infection (P = 0.007) and minor infections (P = 0.006) in poorly controlled diabetics only]. Four studies presented outcomes for total length of stay (LOS). Three of these papers looked specifically at diabetic patients, of which two found no significant differences in length of stay between good and poor preoperative glycaemic control [LOS: P = 0.59 and 0.86 vs P < 0.001]. However, elevated HbA1c vs normal HbA1c was associated with prolonged stay in hospital and in intensive care unit (ICU) in patients irrespective of previous diabetic status [total LOS (P < 0.001)]. Elevated HbA1c levels were also a significant predictor of reduced intraoperative insulin sensitivity in diabetic patients (R = -0.527; P < 0.001). Furthermore, higher HbA1c levels were associated with a reduced incidence of postoperative atrial fibrillation (P = 0.001). We conclude that elevated HbA1c is a strong predictor of mortality and morbidity irrespective of previous diabetic status. In particular, the mortality risk for CABG is quadrupled at HbA1c levels >8.6%. Some studies have called into question the predictive value of HbA1c on short-term outcomes in well-controlled diabetics; however, long-term outcomes in this population have not been reported.

Present-Day Hospital Readmissions after Left Ventricular Assist Device Implantation: A Large Single-Center Study

“…In elective situations, it has been proposed that CABG should be delayed until glycemic control can be achieved. 35 If these results are replicated in an LVAD cohort, closer blood-sugar control is probably warranted, particularly for patients undergoing elective or semielective LVAD implantation.…”

The Red Cell Distribution Width is Strong Predictor for the in-Hospital Mortality of the CABG Patients

“…Some studies were investigated the relationship between alteration of the preoperative ECG and short term mortality (23). The others investigated that the impact of the HbA1c levels on the mortality in CABG patients (2). Although there are some studies related to hematological indices and operative factors such as development of atrial fibrillation and platelet functions, we couldn't find any research associated between hematologic indices and mortality.…”

“…There are some clinical factors such as advanced age, duration of hospitalization, male gender, diabetes mellitus and congestive or chronic heart failure are associated with the short term CABG mortality (1,2). Even though the effects of the high risk patients on the health costs decreased over the time, the economic importance is still maintained (3).…”

Risk Factors of Major Cardiovascular Events in Long-Term Period of Coronary Bypass in Patients With Ischemic Heart Disease and 2nd Type Diabetes Mellitus

“…В систематическом обзоре 11 исследо-ваний по оценке влияния уровня гликированного гемо-глобина на результаты КШ его авторы пришли к заклю-чению, что повышенный уровень гликированного гемоглобина является строгим предиктором смертно-сти и развития осложнений независимо от предыду-щего диабетического статуса. В частности, риск леталь-ного исхода при КШ возрастал в 4 раза при уровне гликированного гемоглобина >8,6% [13]. Также предик-торами сердечно-сосудистых осложнений после карди-альных операций были лабильность уровня глюкозы (ОР 1,3; 95% ДИ 1,1-1,5; р=0,03) и повышение среднего уровня глюкозы в первые 4 часа после операции (ОР 1,2; 95% ДИ 1,0-1,4; р=0,03) [12].…”