Can Pre-Operative HbA1c Values in Coronary Surgery be a Predictor of Mortality?

Aydınlı, Bahar; Demir, Aslı; Özmen, Harun; Vezir, Özden; Ünal, Utku; Özdemir, Mustafa

doi:10.5152/tjar.2018.46667

Cited by 11 publications

(10 citation statements)

References 23 publications

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“…Kotfis et al [ 26 ] showed that elevated HbA1c levels are associated with postoperative delirium regardless of the diagnosis of diabetes. Those results are supported by previous studies [ 9 – 16 ] but contradict others [ 17 – 19 ]. Differences in patient characteristics, ethnicity, and genetics might be involved in the discrepancies.…”

Section: Discussionsupporting

confidence: 88%

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Relationship between Perioperative Cardiovascular Events and Glycated Hemoglobin in Diabetic Patients Undergoing Noncardiac Surgery

Chen

Ding

Yuan

et al. 2020

BioMed Research International

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This retrospective nested case-control study is aimed at investigating the relationship between HbAlc and perioperative cardiovascular events (PCE) in patients with diabetes who underwent complex or moderately complex noncardiac surgery at the Second Affiliated Hospital of Xinjiang Medical University in 2013-2018. The patients were divided into four groups according to HbA1c ≤7%, 7.1%-7.9%, 8.0%-8.9%, and ≥9%. The occurrence of PCE among the groups was compared using univariable and multivariable analyses. Finally, 318 patients were included. There were 90 cases of PCE among the 318 patients; the occurrence rate of PCE was 28.3%. No death occurred. The occurrence rates of PCE in the HbA 1 c ≥ 8.0 % − 8.9 % and HbA 1 c ≥ 9.0 % groups were 30.8% and 35.4%, respectively ( P < 0.001 vs. the HbA1c 7.1%-7.9% group). The occurrence rate of PCE in the HbA 1 c ≤ 7 % group was 25.9% ( P > 0.05 vs. the HbA1c 7.1%-7.9% group). The multivariable logistic regression analysis showed that the course of diabetes (HbA1c stratification ≤7%, 7.1%-7.9%, 8.0%-8.9%, ≥9%, OR = 3.672 , 95% CI: 1.552-8.687), HbA1c ( OR = 1.895 , 95% CI: 1.227-4.830), SBP ( OR = 1.194 , 95% CI: 1.015-2.023), and microalbuminuria ( OR = 1.098 , 95% CI: 1.005-1.023) was independently associated with PCE in diabetic patients. In conclusion, HbA1c levels are related to the incidence of PCE in diabetic patients undergoing complex or moderately complex noncardiac surgery.

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Section: Discussionsupporting

confidence: 88%

“…HbA1c is a good indicator to evaluate the blood glucose level of diabetic patients [ 1 ]. Nevertheless, previous studies report conflicting results about the association between HbA1c levels and PCE, with studies reporting an association [ 9 – 16 ] and other reporting a lack of association [ 17 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

Relationship between Perioperative Cardiovascular Events and Glycated Hemoglobin in Diabetic Patients Undergoing Noncardiac Surgery

Chen

Ding

Yuan

et al. 2020

BioMed Research International

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“…The study found that there was no difference in the incidence of cardiovascular events in patients with HbA1c <6.5% and >6.5%: AF (26.3% vs 26.6%;P= 0.90), acute MI (0.5% vs 0; P= 0.333) and cardiac tamponade (0 vs 0.2%; P= 0.313). Other studies similarly showed that there was no significant difference in the incidence of cardiovascular events between patients with raised HbA1c levels and those with normal levels 38,40,44,45 . Kinoshita et al 43 carried out a retrospective analysis of 912 patients who underwent isolated CABG.…”

Section: Cardiovascular Events With Poorly Controlled Hba1cmentioning

confidence: 89%

“…The evidence on the effect of HbA1c levels on mortality is contradictory with some studies reporting that increased HbA1c levels are associated with increased mortality [18][19][20][21][22][23][24][25] . But by in large, most studies seem to show that increased HbA1c is not predictive of increased mortality as solo indicator [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] . The findings from all these studies are summarised in Table 1 and Table 2.…”

Section: Hba1c and Mortality Ratesmentioning

confidence: 99%

“…The study found that HbA1c was not a significant predictor of post-operative mortality (P= 0.88). Further studies similarly showed that there was no significant difference in mortality following cardiac surgery according to HbA1c levels, regardless of the HbA1c cut-off levels utilised [28][29][30][31][32][34][35][36][37][38][39][40] .…”

Section: Hba1c and Mortality Ratesmentioning

confidence: 99%

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Glycated Hb levels and its effect on outcomes in Cardiac Surgery

et al.

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There remains a significant paucity of information evaluating the effect of glycated HbA1c levels and its theorized effect on mortality and morbidity rates following cardiac surgery. Diabetes is a very common comorbidity in patients undergoing open heart surgery as there is shift in patient characteristics and being higher risk. Currently, the evidences are controversial and there is no clear consensus that increased HbA1c levels is associated with an increased perioperative mortality rate. However, reported literature are more commonly able to demonstrate elevated HbA1c levels to be associated with increased rates of wound infection, cardiovascular events and renal failure; thus, higher morbidities postoperatively. This literature review aims to examine the evidence synthesis behind each of morbidities and mortalities associated with open heart surgery and the impact of high HbA1c on the reported outcomes.

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Impact of preoperative glycometabolic status on outcomes in cardiac surgery: Systematic review and meta-analysis

Corazzari

Matteucci

Kołodziejczak

et al. 2022

The Journal of Thoracic and Cardiovascular Surgery

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Background: Historically, impaired glucose metabolism has been associated with early and late complicated clinical outcomes after cardiac surgery; however, such a condition is not specific to subjects with diabetes mellitus and involves a larger patient population.Methods: Databases were screened (January 2000 to December 2020) to identify eligible articles; studies that evaluated the association between preoperative metabolic status, as assessed by glycosylated hemoglobin levels and clinical outcomes, were considered. The studies were stratified in thresholds by baseline glycosylated hemoglobin level (lower vs higher).Results: Thirty studies, involving 34,650 patients, were included in the review. In a meta-analysis stratified by glycosylated hemoglobin levels, early mortality was numerically reduced in each threshold comparison and yielded the highest reductions when less than 5.5% versus greater than 5.5% glycosylated hemoglobin levels were compared (risk ratio, 0.39; 95% confidence interval, 0.18-0.84; P ¼ .02). Comparing higher glycosylated hemoglobin threshold values yielded comparable results. Late mortality was reduced with lower levels of glycosylated hemoglobin. Low preoperative glycosylated hemoglobin was associated with the lowest risk of sternal wound infections (risk ratio, 0.50; 95% confidence interval, 0.32-0.80; P ¼ .003 and risk ratio, 0.53; 95% confidence interval, 0.39-0.70; P < .0001) for comparisons of less than 7.5% versus greater than 7.5% and less than 7.0% versus greater than 7.0% glycosylated hemoglobin thresholds, respectively. Additionally, levels of glycosylated hemoglobin lower than 7% were associated with reduced hospital stay, lower risk of stroke/transient ischemic attack (risk ratio 0.53; 95% confidence interval, 0.39-0.70; P < .0001), and acute kidney injury (risk ratio, 0.65; 95% confidence interval, 0.54-0.79; P < .0001).Conclusions: Lower levels of glycosylated hemoglobin in patients undergoing cardiac surgery are associated with a lower risk of early and late mortality, as well as in the incidence of postoperative acute kidney injury, neurologic complications, and wound infection, compared with higher levels.

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Can Pre-Operative HbA1c Values in Coronary Surgery be a Predictor of Mortality?

Cited by 11 publications

References 23 publications

Relationship between Perioperative Cardiovascular Events and Glycated Hemoglobin in Diabetic Patients Undergoing Noncardiac Surgery

Relationship between Perioperative Cardiovascular Events and Glycated Hemoglobin in Diabetic Patients Undergoing Noncardiac Surgery

Glycated Hb levels and its effect on outcomes in Cardiac Surgery

Impact of preoperative glycometabolic status on outcomes in cardiac surgery: Systematic review and meta-analysis

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