Relationship between preoperative hemoglobin A1c levels and long-term mortality after coronary artery bypass grafting in patients with type 2 diabetes mellitus

Kuhl, Jeanette; Sartipy, Ulrik; Eliasson, Björn; Nyström, Thomas; Holzmann, Martin J.

doi:10.1016/j.ijcard.2015.09.008

Cited by 38 publications

(40 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Similarly, Narayan et al [4] reported an increased mortality with Hba1c >6.5% on a univariate analysis, which was eventually not statistically significant after a multivariate analysis. A multicenter study by Kuhl et al [14] also reported an increasing in 30-day and long-term mortality associated with increasing preoperative Hba1c levels. On the contrary, several studies failed to show a statistically significant difference in terms of mortality between controlled and uncontrolled diabetic groups [3,13].…”

Section: Discussionmentioning

confidence: 90%

Effect of glycemic control on mortality and infections in patients undergoing coronary artery bypass grafting: a Genesee County experience

Khan

Wahab

et al. 2019

Journal of Community Hospital Internal Medicine Perspectives

View full text Add to dashboard Cite

Background: We report post-coronary artery bypass outcomes and factors affecting the outcomes from the Genesee County, MI, where the population is distinctly characterized by a higher prevalence of renal failure (RF), diabetes, obesity and smoking than the national average. Methods: We performed a retrospective cohort study on 1133 patients undergoing isolated CABG at our hospital from June 2012 to July 2017. Primary outcome was the association between preoperative hemoglobin A1c (HbA1c) and all-cause postoperative mortality after CABG, secondary outcomes included the association between HbA1c and a composite of postoperative infections including sternal-wound infections, leg harvest-site infections, pneumonia or sepsis. Logistic Regression analyses were also performed. Results: There was no difference in the mortality rate (OR 1.0, 95% CI 0.4-2.3) and composite of all infections (OR 1.0, 95% CI 0.7-1.6) between the controlled (HbA1c ≤7%) and uncontrolled (HbA1c >7%) groups. However, RF (OR 5.9, 95% CI 1.5-22.9), smoking (OR 3.7, 95% CI 1.3-11.2) and ejection fraction <35% (OR 3.4, 95% CI 1.4-8.3) were independently associated with increased mortality after CABG. Additionally, low EF (OR 2.4, 95% CI 1.4-4.1) and smoking (OR 2.3, 95% CI 1.2-4.1) were associated with an increased rate of composite of all infections after CABG. Conclusion: Although not different in controlled and uncontrolled diabetic groups, mortality, in our population was associated with comorbidities like RF, smoking and congestive heart failure that are highly prevalent, emphasizing the need for interventions at primary care level to improve the postoperative outcomes after CABG.

show abstract

Section: Discussionmentioning

confidence: 90%

Effect of glycemic control on mortality and infections in patients undergoing coronary artery bypass grafting: a Genesee County experience

Khan

Wahab

et al. 2019

Journal of Community Hospital Internal Medicine Perspectives

View full text Add to dashboard Cite

show abstract

“…By contrast, maintaining intensive glycemic control in our patient with coronary artery disease that required triple coronary stent insertion might not be appropriate because this will not only increase the risk of hypoglycemia (25) but would further increase his cardiovascular risk and mortality (26). It has been previously reported that in patients with T2DM who previously underwent coronary artery bypass grafting, and those with HbA 1c levels >9.0% had significantly increased risk of death, whereas those with HbA 1c levels >8.1% had increased risk for combined outcome of death or major adverse cardiovascular event (27). Because patients with CD are at significantly increased risk of cardiovascular disease (28), we recommend maintaining less intensive glycemic targets (HbA 1c between 7.0 and 8.0%) for patients with CD controlled on long-term medical therapy with concurrent T2DM to minimize the risks of hypoglycemic episodes that may precipitate future cardiovascular events.…”

Section: Discussionmentioning

confidence: 96%

Effective Medical Therapy for Cushing Disease Can Increase the Susceptibility to Relative Hypocortisolism

Yuen

Mercado

Moloney

et al. 2018

AACE Clinical Case Reports

View full text Add to dashboard Cite

Objective: Pasireotide is approved for treatment of adults with Cushing disease (CD) with persistent hypercortisolism for whom surgery has failed or is not an option. Effective medical therapy for CD may increase the susceptibility of relative hypocortisolism during acute stress because of a patient's inability to compensate by increasing endogenous adrenocorticotropic hormone (ACTH) and cortisol secretion. We describe a patient with CD on pasireotide therapy for 7 years in whom biochemical eucortisolemia was achieved but subsequently experienced several distinct episodes of relative hypocortisolism during periods of acute illness.Methods: A 67-year-old man with biochemical confirmation of CD exhibited clinical and biochemical features of persistent hypercortisolism after transsphenoidal surgery despite pituitary magnetic resonance imaging showing no residual or recurrent tumor. He was enrolled into a phase 3 study (NCT00434148) and was initated on twice-daily subcutaneous pasireotide.Results: Long-term pasireotide therapy normalized 24-hour urinary free cortisol, serum cortisol, and ACTH levels. The patient subsequently developed type 2 diabetes mellitus and was managed effectively with oral hypoglycemic agents and insulin therapy. During a routine clinic assessment 79 months after study enrollment, he reported symptoms suggestive of relative hypocortisolism during three distinct substantially acute stressful health events in the preceding 18 months.Conclusion: Successful achievement of eucortisolemia with long-term medical therapy may increase susceptibility to relative hypocortisolism and precipitate symptoms of adrenal insufficiency during periods of acute stress in patients with CD. We recommend that such patients should be counseled on glucocorticoid stress dosing to prevent such events that could lead to adrenal crisis. (AACE Clinical Case Rep. 2018;4:e1-e6) Abbreviations: ACTH = adrenocorticotropic hormone; CD = Cushing disease; FPG = fasting plasma glucose; GH = growth hormone; HbA 1c = hemoglobin A 1c ; T2DM = type 2 diabetes mellitus; TSS = transsphenoidal surgery; UFC = urinary free cortisol

show abstract

“…Improved perioperative blood glucose control and the use of insulin perfusion may contribute to improved operative outcomes in diabetic patients [25]. Kuhl et al [26] in a study examining long-term outcomes after coronary bypass surgery in patients with type 2 diabetes mellitus suggested that mortality increased when HbA1c levels were>9% and morbidity and complications increased when the levels were>8.1%. However, in the same study, mortality was not found to be associated with HbA1c levels in patients using insulin.…”

Section: Discussionmentioning

confidence: 99%

Tracing the Proposed Adverse Effects of Higher Values of Glycosylated Hemoglobin (HbA1c) in Tightly-Controlled Diabetic Patients Undergoing Primary CABG

Elsayed¹,

Eid²

2019

IJCTS

View full text Add to dashboard Cite

Objectives:The rising percentage of patients scheduled for primary CABG with HbA1c>8.6% is alarming reflecting higher burden on the patient, operative procedure and the operating surgeon. Although some articles in the literature argue that decompensated diabetes increases mortality and morbidity, other studies are arguing that there is no relation between them. This study aims at tracing the occurrence of the proposed adverse complications after primary CABG operations related to HbA1c values>8.6% in diabetics subjected to tight glycemic control; in a trial to conclude how far the value of HbA1c could be accepted to carry out the surgery safely. Methods:This prospective study included 80 adult diabetic patients who presented with IHD requiring primary CABG. It was conducted between January 2016 and December 2018. Group (I) included 42 patients with HbA1c values<8.6% and group (II) included 38 patients with HbA1c values>8.6%. We compared the following: perioperative MI, low cardiac output syndrome, operative mortality, rhythmic complications, hemorrhagic complications, respiratory complications, cerebrovascular accidents, acute renal failure development, superficial and deep surgical wounds infections, overall hospital complications and overall one-year mortality and survival. Results: Mean HbA1c% value was 7.5 ± 1.11% for group (I) and 9.3 ± 1.03% for group (II). Prior to surgery, the mean FBG level was 136.9±41.7 mg/dl for group (I) and 152.2±27.3 mg/dl for group (II) with tight glycemic control measures. Although group (II) showed higher values in the studied parameters (pre-, intra-and post-operatively), no statistically significant differences appeared between the two subsets of patients regarding the proposed adverse complications. The overall hospital complication rate was 13(30.95%) and 14(36.84%) for group (I) and (II) respectively (p>0.05). In the follow-up period, both groups expressed comparable results with no statistical significance. The overall one-year survival was 95.23% and 94.73% in group (I) and (II) respectively (p>0.05) and the overall mortality was 5% (two deaths from each group) (p>0.05). Conclusion:Although patients with IHD undergoing primary CABG and having decompensated diabetes with HbA1c values>8.6% have more insulted cardiovascular condition, these higher HbA1c values do not add more additional impact on the proposed adverse intra-and postoperative complications as with lower values with the aid of strict (tight) glycemic control measures in the immediate preoperative period.

show abstract

Relationship between preoperative hemoglobin A1c levels and long-term mortality after coronary artery bypass grafting in patients with type 2 diabetes mellitus

Cited by 38 publications

References 47 publications

Effect of glycemic control on mortality and infections in patients undergoing coronary artery bypass grafting: a Genesee County experience

Effect of glycemic control on mortality and infections in patients undergoing coronary artery bypass grafting: a Genesee County experience

Effective Medical Therapy for Cushing Disease Can Increase the Susceptibility to Relative Hypocortisolism

Tracing the Proposed Adverse Effects of Higher Values of Glycosylated Hemoglobin (HbA1c) in Tightly-Controlled Diabetic Patients Undergoing Primary CABG

Contact Info

Product

Resources

About