Postoperative Hyperglycemia and Atrial Fibrillation After Coronary Artery Bypass Graft Surgery

Tatsuishi, Wataru; Adachi, Hitoshi; Murata, Makoto; Tomono, Junichi; Okonogi, Shuichi; Okada, Syuichi; Ezure, Masahiko; Kaneko, Tatsuo; Ohshima, Shigeru

doi:10.1253/circj.cj-14-0989

Cited by 21 publications

(21 citation statements)

References 39 publications

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“…33,34 Furthermore, the presence of high HbA1c levels (i.e., >7% or >8.6% 35) ) and/or hyperglycemia after cardiac surgery has been shown to be associated with POAF. 36) We observed no association between POAF and HbA1c values, possibly because HbA1c levels were relatively low (<7%) in our study population. These results suggest that postoperative CGM data analysis could be useful in predicting several postoperative complications 13) with higher accuracy than HbA1c.…”

Section: Discussioncontrasting

confidence: 62%

“…These variations in glucose levels are likely missed during intermittent blood glucose measurement by self-monitoring of blood glucose (SMBG). 11) In particular, CGM data revealed that the maximum, mean, and standard deviation values of glucose levels were higher during SQII than during CIII. It should, however, be noted that glucose levels exceeded the target level in 2.8% of the CIII period and 13% of the SQII period, indicating that glucose management using the insulin sliding scale during SQII requires further optimization.…”

Section: Discussionmentioning

confidence: 94%

“…1,[4][5][6] Although intensive insulin therapy is effective in achieving normoglycemia (81-108 mg/dL) in critically ill patients, 7) it often leads to hypoglycemic events and increased mortality in these patients. 8,9) Several recent studies have shown that hyperglycemia and hypoglycemia during surgery, including cardiovascular surgery, are associated with poor outcomes, including the increased risk of adverse events such as surgical site infections (SSI), 1,2,10) postoperative atrial fibrillation (POAF) 11) and coronary artery events, 12) increased duration of hospital stay, 1,13) and increased mortality. 3,5,[14][15][16] Although high blood glucose variability is associated with poor outcomes in critically ill patients, [12][13][14][15] the relationship between blood glucose variability and complications after cardiovascular surgery has not been adequately clarified.…”

Section: Introductionmentioning

confidence: 99%

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Glucose Variability Based on Continuous Glucose Monitoring Assessment Is Associated with Postoperative Complications after Cardiovascular Surgery

Sato

Hosojima

Ishikawa

et al. 2017

ATCS

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Purpose: This purpose of this prospective study was to use a continuous glucose monitoring (CGM) system to evaluate the suitability of our institution's glucose management protocol after cardiovascular surgery and to clarify the impact of glycemic variability on postoperative complications. Methods: In all, 76 patients who underwent elective cardiovascular surgery and were monitored perioperatively using a CGM system were evaluated. Postoperative glucose management consisted of continuous intravenous insulin infusion (CIII) in the intensive care unit, and subcutaneous insulin injections (SQII) after oral food intake started. CIII and subcutaneous injections were initiated when blood glucose level exceeded 150 mg/dL. CGM data were used to analyze perioperative glycemic variability and association with postoperative complications. Results: Target glucose levels (71-180 mg/dL) were achieved during 97.1 ± 5.5% and 86.4 ± 19.0% of the continuous insulin infusion and subcutaneous injection periods, respectively. Major postoperative complications were surgical site infections, found in 6.6% of total patients, and atrial fibrillation, found in 44% of patients with off-pump coronary artery bypass grafting. High glycemic variability during SQII was associated with increased risk for both complications. Conclusion: Data analysis revealed that our glucose management protocol during CIII was adequate. However, the management protocol during SQII required improvement.

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Section: Discussioncontrasting

confidence: 62%

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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Glucose Variability Based on Continuous Glucose Monitoring Assessment Is Associated with Postoperative Complications after Cardiovascular Surgery

Sato

Hosojima

Ishikawa

et al. 2017

ATCS

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“…Interestingly, melanogenesis, insulin secretion, and the thyroid hormone signaling pathways were found to be the potentially affected pathways. Tatsuishi et al reported that blood glucose is a very strong predictor of PoAF after CABG 13. More importantly, we found that fasting blood glucose was increased in patients with high hsa_circ_025016 expression levels.…”

Section: Discussionsupporting

confidence: 59%

Plasma Circular RNAs, Hsa_circRNA_025016, Predict Postoperative Atrial Fibrillation After Isolated Off‐Pump Coronary Artery Bypass Grafting

Zhang

Shu

et al. 2018

JAHA

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BackgroundCircular RNAs (circRNAs) are pervasively expressed in highly divergent eukaryotes and are stable in body fluids. However, the link between circRNAs and onset of atrial fibrillation (AF) has not previously been investigated. We aimed to identify plasma circRNAs that are able predict AF after cardiac surgery.Methods and ResultsPlasma circRNA expression profiles were investigated in a total of 769 patients with or without AF after isolated off‐pump coronary artery bypass grafting. First, a circRNA microarray was used to screen 13 617 human circRNAs in plasma samples from patients in the discovery cohort (n=30). A quantitative polymerase chain reaction assay was then applied to evaluate the expression of 9 selected circRNAs in the training cohort (n=365). This approach revealed that hsa_circRNA_025016 was upregulated in patients with new‐onset AF with a high diagnostic accuracy as assessed by the area under the receiver operating characteristic curve (=0.802). Additionally, a satisfactory diagnostic performance of hsa_circRNA_025016 was found in the validation cohort (n=284). Furthermore, Kyoto Encyclopedia of Genes and Genomes biological pathway analysis indicated that hsa_circ_025016 participated in melanogenesis, insulin secretion, and the thyroid hormone signaling pathway. A positive correlation between hsa_circ_025016 and fasting blood glucose was also identified in both cohorts.ConclusionsHsa_circ_025016 is a potential biomarker for predicting new‐onset AF after isolated off‐pump coronary artery bypass grafting.

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“…To prevent PoAF and to improve treatment outcomes after CABG, routine prophylactic antiarrhythmic therapy could be administered, but because of reasons of side effects and added drug costs, it is desirable to select only high‐risk patients for treatment. The most consistent risk factor for postoperative AF is advanced age, but also body mass index,2 hyperglycemia,3 and left atrial enlargement4 predict post CABG‐AF in some studies. Despite the identification of these risk factors, there is no widely accepted risk model to predict post‐CABG AF5 and as such, there is an urgent need to identify novel biomarkers for PoAF.…”

mentioning

confidence: 99%

Circulating Circles Predict Postoperative Atrial Fibrillation

Reckman

Creemers

2018

JAHA

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Postoperative Hyperglycemia and Atrial Fibrillation After Coronary Artery Bypass Graft Surgery

Cited by 21 publications

References 39 publications

Glucose Variability Based on Continuous Glucose Monitoring Assessment Is Associated with Postoperative Complications after Cardiovascular Surgery

Glucose Variability Based on Continuous Glucose Monitoring Assessment Is Associated with Postoperative Complications after Cardiovascular Surgery

Plasma Circular RNAs, Hsa_circRNA_025016, Predict Postoperative Atrial Fibrillation After Isolated Off‐Pump Coronary Artery Bypass Grafting

Circulating Circles Predict Postoperative Atrial Fibrillation

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