Preoperative hemoglobin A1c predicts atrial fibrillation after off-pump coronary bypass surgery

Kinoshita, Takeshi; Asai, Tomohiro; Suzuki, Tomoaki; Kambara, Atsushi; Matsubayashi, Keiji

doi:10.1016/j.ejcts.2011.04.011

Cited by 44 publications

(55 citation statements)

References 18 publications

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“…Although it has been shown that higher HbA 1c values may decrease the risk of atrial fibrillation (30) and mortality in patients with acute hyperglycemia (31), we found only a nonsignificant trend for decreasing the risk of complications. The protective effect mentioned above and a decreased risk of hypoglycemic events could be an explanation for this phenomenon.…”

Section: Discussioncontrasting

confidence: 95%

Diabetes and the Association of Postoperative Hyperglycemia With Clinical and Economic Outcomes in Cardiac Surgery

et al. 2016

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OBJECTIVEThe management of postoperative hyperglycemia is controversial and generally does not take into account pre-existing diabetes. We analyzed clinical and economic outcomes associated with postoperative hyperglycemia in cardiac surgery patients, stratifying by diabetes status.RESEARCH DESIGN AND METHODSMulticenter cohort study in 4,316 cardiac surgery patients operated on in 2010. Glucose was measured at 6-h intervals for 48 h postoperatively. Outcomes included cost, hospital length of stay (LOS), cardiac and respiratory complications, major infections, and death. Associations between maximum glucose levels and outcomes were assessed with multivariable regression and recycled prediction analyses.RESULTSIn patients without diabetes, increasing glucose levels were associated with a gradual worsening of outcomes. In these patients, hyperglycemia (≥180 mg/dL) was associated with an additional cost of $3,192 (95% CI 1,972 to 4,456), an additional hospital LOS of 0.8 days (0.4 to 1.3), an increase in infections of 1.6% (0.5 to 2.8), and an increase in respiratory complications of 2.6% (0.0 to 5.3). However, among patients with insulin-treated diabetes, optimal outcomes were associated with glucose levels considered to be hyperglycemic (180 to 240 mg/dL). This level of hyperglycemia was associated with cost reductions of $6,225 (−12,886 to −222), hospital LOS reductions of 1.6 days (−3.7 to 0.4), infection reductions of 4.1% (−9.1 to 0.0), and reductions in respiratory complication of 12.5% (−22.4 to −3.0). In patients with non–insulin-treated diabetes, outcomes did not differ significantly when hyperglycemia was present.CONCLUSIONSGlucose levels <180 mg/dL are associated with better outcomes in most patients, but worse outcomes in patients with diabetes with a history of prior insulin use. These findings support further investigation of a stratified approach to the management of patients with stress-induced postoperative hyperglycemia based on prior diabetes status.

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Section: Discussioncontrasting

confidence: 95%

Diabetes and the Association of Postoperative Hyperglycemia With Clinical and Economic Outcomes in Cardiac Surgery

et al. 2016

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“…[1][2][3] On the other hand, several studies in past years have found that higher HbA1c levels lead to adverse outcomes in patients. [8][9][10][11][12] The present study found that preoperative FBS levels have higher association with arrhythmia, atelectasis and prolonged mechanical ventilation while preoperative HbA1C levels are of higher association with IABP, massive bleeding (>1000 mL/24h) and multi-organ failure. Former studies suggest that preoperative higher blood glucose levels raise the risk of infection and tighten inflammatory responses.…”

Section: Discussionmentioning

confidence: 99%

Hyperglycemia or High Hemoglobin A1C: Which One is More Associated with Morbidity and Mortality after Coronary Artery Bypass Graft Surgery?

Faritous

Ardeshiri

Yazdanian

et al. 2014

ATCS

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Propose: Our aim was to determine which criterion-hyperglycemia or high levels of glycosylated hemoglobin (HbA1C) is more associated with increased mortality and morbidity after coronary artery bypass graft (CABG). Methods: Two hundred and sixteen patients who underwent elective CABG were enrolled in this prospective study. In order to compare postoperative outcomes regarding HbA1c and fasting blood sugar (FBS) levels, the patients were divided into two groups based on plasma HbA1c levels >7% or ≤7% and FBS >126 mg/dl or ≤126 mg/dl. Results: Of 216 studied patients, 165 and 51 cases had levels of HbA1C ≤7% and HbA1c

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“…However, some studies identified the influence of diabetes in AF incidence, but results still controversial. (15,16) …”

Section: Discussionmentioning

confidence: 99%

Predictive factors of atrial fibrillation after coronary artery bypass grafting

Folla

Melo

Silva

2016

Einstein (São Paulo)

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Objective To analyze predictive demographic and perioperative variables of postoperative atrial fibrillation in patients who underwent exclusively coronary artery bypass grafting.Methods This was a retrospective cohort. We randomly selected 105 medical records of patients who underwent exclusively coronary artery bypass grafting in 2014. Demographic, clinical (preoperative and immediate postoperative) data and related with surgical procedure were collected from medical records. The occurrence of postoperative atrial fibrillation was considered until the third day after the surgery. Variables were analyzed using descriptive and inferential statistics. To identify predictive factors of postoperative atrial fibrillation we used a decision tree model with Classification and Regression Trees algorithm.Results Atrial fibrillation incidence was 19.0% (n=20). Patients with left atrial >40.5mm and aged >64.5 years were more likely to develop the arrhythmia during the post-surgical period.Conclusion Left atrial diameter and advanced age were predictive factors of atrial fibrillation in patients who underwent exclusively coronary artery bypass grafting.

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Preoperative hemoglobin A1c predicts atrial fibrillation after off-pump coronary bypass surgery

Abstract: Preoperative hemoglobin A1c independently predicts the occurrence of AF after isolated off-pump coronary bypass grafting.

Cited by 44 publications

References 18 publications

Diabetes and the Association of Postoperative Hyperglycemia With Clinical and Economic Outcomes in Cardiac Surgery

Diabetes and the Association of Postoperative Hyperglycemia With Clinical and Economic Outcomes in Cardiac Surgery

Hyperglycemia or High Hemoglobin A1C: Which One is More Associated with Morbidity and Mortality after Coronary Artery Bypass Graft Surgery?

Predictive factors of atrial fibrillation after coronary artery bypass grafting

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