Glycemic control and risk factors for <scp>in‐hospital</scp> mortality and vascular complications after coronary artery bypass grafting in patients with and without preexisting diabetes

Diabetes Obesity Metabolism

et al. 2023

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Aims: To investigate the impact of stress hyperglycaemia (SH) on in-hospital adverse cardiac events after coronary artery bypass grafting (CABG) in patients without diabetes.Materials and Methods: In total, 5450 patients without diabetes who underwent CABG were analysed. SH was defined as any two instances in which the random blood glucose level was >7.8 mmol/L after CABG in the intensive care unit (ICU). The primary outcome was major adverse cardiac events (MACEs), including in-hospital mortality, acute myocardial infarction, stroke and acute renal failure. Secondary outcomes included surgical site infection (SSI) and length of ICU stay.Results: Patients with SH had higher rates of MACEs (5.7% vs. 2.3%, p < .0001) and higher SSI (3.3% vs. 1.4%, p = .0003) and longer ICU stays (2.6 ± 2.0 vs. 1.3 ± 1.3 days, p < .0001) than those without SH. Furthermore, SH was associated with a higher risk of MACEs [odds ratio (OR): 2.32, 95% confidence interval (CI): 1.38-3.90],

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Association between stress hyperglycaemia and in‐hospital cardiac events after coronary artery bypass grafting in patients without diabetes: A retrospective observational study of 5450 patients

Diabetes Obesity Metabolism

et al. 2023

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“…To explore the association between clinical outcomes and glucose control, patientsʼ glycemic control status was categorized into the following three groups according to MBG after CABG, as we have previously reported [ 7 ]: strict-control group, MBG < 7.8 mmol/L; moderate-control group, MBG from 7.8 to 9.9 mmol/L; and liberal-control group, MBG ≥ 10.0 mmol/L.…”

Section: Methodsmentioning

confidence: 99%

“…Blood glucose fluctuations were more common in patients with strict blood glucose control, resulting in worse outcomes [ 6 ]. Our previous study showed that strict glucose control (< 7.8 mmol/L) was associated with an increased risk of in-hospital mortality in patients with diabetes [ 7 ]. Postoperative glycemic control in diabetic patients undergoing On-pump CABG is challenging for physicians because it depends on both the physicians’ clinical experience and the patients’ response to hypoglycemic therapy [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of glycemic control and glucose fluctuation on in-hospital adverse outcomes after on-pump coronary artery bypass grafting in patients with diabetes: a retrospective study

You

et al. 2023

Diabetol Metab Syndr

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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.

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Effect of early hypoglycaemia on hospitalization outcomes in patients undergoing coronary artery bypass grafting

Diabetes Research and Clinical Practice

et al. 2022