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.
Published in | International Journal of Cardiovascular and Thoracic Surgery (Volume 5, Issue 2) |
DOI | 10.11648/j.ijcts.20190502.12 |
Page(s) | 31-40 |
Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
Copyright |
Copyright © The Author(s), 2019. Published by Science Publishing Group |
Glycosylated Hemoglobin, HbA1c, Diabetic Primary CABG
[1] | Flaherty JD, Davidson CJ. Diabetes and coronary revascularization. JAMA. 2005;293:1501–1508. |
[2] | Schwartz L, Kip KE, Frye RL, Alderman EL, Schaff HV, Detre KM. Bypass Angioplasty Revascularization Investigation Coronary bypass graft patency in patients with diabetes in the Bypass Angioplasty Revascularization Investigation (BARI) Circulation. 2002;106:2652–2658. |
[3] | Ouattara A, Lecomte P, Le Manach Y, Landi M, Jacqueminet S, Platonov I, et al. Poor intraoperative blood glucose control is associated with a worsened hospital outcome after cardiac surgery in diabetic patients. Anesthesiology. 2005;103:687–94. |
[4] | Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS. Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. Circulation. 2004;109:1497–502. |
[5] | Tennyson C, Lee R, Attia R. Is there a role for HbA1c in predicting mortality and morbidity outcomes after coronary artery bypass graft surgery? Interact CardiovascThorac Surg. 2013;17:1000–8. |
[6] | Faritous Z, Ardeshiri M, Yazdanian F, Jalali A, Totonchi Z, Azarfarin R. Hyperglycemia or high hemoglobin A1C: Which one is more associated with morbidity and mortality after coronary artery bypass graft surgery? Ann ThoracCardiovasc Surg. 2014;20:223–8. |
[7] | Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E. Management of hyperglycemia in type 2 diabetes: a patient- centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) Diabetes Care. 2012;35:1364–1379. |
[8] | Knapik P, Ciésla D, Filipiak K, Knapik M, Zembala M. Prevalence and clinical significance of elevated preoperative glycosylated hemoglobin in diabetic patients scheduled for coronary artery surgery. Eur J Cardiothorac Surg. 2011;39:484–9. |
[9] | Engoren M, Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, et al. The prevalence of elevated hemoglobin A1c in patients undergoing coronary artery bypass surgery. J CardiothoracSurg. 2008;3:63. |
[10] | Subramaniam B, Lerner A, Novack V, Khabbaz K, Paryente-Wiesmann M, Hess P, et al. Increased glycemic variability in patients with elevated preoperative HbA1C predicts adverseoutcomes following coronary artery bypass grafting surgery. AnesthAnalg. 2014;118:277–87. |
[11] | Anand SS, Razak F, Vuksan V, Gerstein HC, Malmberg K, Yi Q, et al. Diagnostic strategies to detect glucose intolerance in a multiethnic population. Diabetes Care. 2003;26:290–6. |
[12] | Davidson MB, Schriger DL, Peters AL, Lorber B. Relationship between fasting plasma glucose and glycosylated hemoglobin: potential for false-positive diagnoses of type 2 diabetes using new diagnostic criteria. JAMA. 1999;281:1203–10. |
[13] | Reynolds TM, Smellie WS, Twomey PJ.Glycatedhaemoglobin (HbA1c) monitoring.BMJ. 2006;333:586–588. |
[14] | Roques F, Michel P, Goldstone AR. The logistic EuroSCORE. Eur Heart J. 2003;24:882–883. |
[15] | Shroyer AL, Coombs LP, Peterson ED, Eiken MC, DeLong ER, Chen A, Ferguson TB, Jr, Grover FL, Edwards FH, Society of Thoracic Surgeons The Society of Thoracic Surgeons: 30-day operative mortality and morbidity risk models. Ann Thorac Surg. 2003;75:1856–1864. |
[16] | Halkos ME, Puskas JD, Lattouf OM, Kilgo P, Kerendi F, Song HK, et al. Elevated preoperative hemoglobin A1c level is predictive of adverse events after coronary artery bypass surgery. J ThoracCardiovasc Surg. 2008 Sep;136:631–40. |
[17] | J. Blaha, P. Kopecky, M. Matias, R. Hovorka, J. Kunstyr, T. Kotulak, et al.:Comparison of three protocols for tight glycemic control in cardiac surgery patients. Diabetes Care, 32 (5) (2009), pp. 757-761. |
[18] | Masla M, Gottschalk A, Durieux ME, Groves DS. HbA1c and diabetes predict perioperative hyperglycemia and glycemic variability in on-pump coronary artery bypass graft patients. J CardiothoracVascAnesth. 2011;25:799–803. |
[19] | Engoren M, Habib RH, Zacharias A, Schwann TA, Riordan CJ. The prevalence of elevated hemoglobin A1c in patients undergoing coronary artery bypass surgery. J Cardiothorac Surg. 2008;3:63. |
[20] | Halkos ME, Lattouf OM, Puskas JD, Kilgo P, Cooper WA, Morris CD, Guyton RA, Thourani VH. Elevated preoperative hemoglobin A1c level is associated with reduced long-term survival after coronary artery bypass surgery. Ann Thorac Surg. 2008;86:1431–1437. |
[21] | Hudson CC, Welsby IJ, Phillips-Bute B, Mathew JP, Lutz A, Chad Hughes G, Stafford-Smith M, Cardiothoracic Anesthesiology Research Endeavors (C. A. R. E.) Group Glycosylated hemoglobin levels and outcome in non-diabetic cardiac surgery patients. Can J Anesth. 2010;57:565–572. |
[22] | H. Sato, G. Carvalho, T. Sato, R. Lattermann, T. Matsukawa, T. Schricker: The association of preoperative glycaemic control, intraoperative insulin sensitivity and outcomes after cardiac surgery. J ClinEndocrinolMetab, 95 (2010), pp. 4338-4344. |
[23] | Nilsson PM, Cederholm J, Zethelius BR. Trends in blood pressure control in patients with type 2 diabetes: data from the Swedish National Diabetes Register (NDR). Blood Press 2011;20:34854. |
[24] | Halimi S. Dyslipidemia of diabetes and insulin resistance.Nephrologie 2000;21(7):345-6. |
[25] | WahbyEhab A, Abo Elnasr Mohamed M, Eissa Michael I, Mahmoud Sahbaa M. Perioperative glycemic control in diabetic patients undergoing coronary artery bypass graft surgery. J Egypt SocCardiothorac Surg. 2016;24:143-9. |
[26] | Kuhl J, Sartipy U, Eliasson B, Nyström T, Holzmann MJ. Relationship between preoperative hemoglobin A1c levels and long- term mortality after coronary artery bypass grafting in patients with type 2 diabetes mellitus. Int J Cardiol. 2016;202:291–6. |
[27] | MonaRamadan, AhmedAbdelgawad, AhmedElshemy, EmadSarawy, AlyEmad, MahmoudMazen, AhmedAbdel Aziz. Impact of elevated glycosylated hemoglobin on hospital outcome and 1 year survival of primary isolated coronary artery bypass grafting patients. The Egyptian Heart Journal. Volume 70, Issue 2, June 2018, Pages 113-118. |
[28] | Bardia A, Khabbaz K, Mueller A, Mathur P, Novack V, Talmor D, et al. The Association Between Preoperative Hemoglobin A1C and Postoperative Glycemic Variability on 30-Day Major Adverse Outcomes Following Isolated Cardiac Valvular Surgery. AnesthAnalg. 2017;124:16–22. |
[29] | BaharAydınlı, AslıDemir, HarunÖzmen, ÖzdenVezir, UtkuÜnal, and Mustafa Özdemir. Can Pre-Operative HbA1c Values in Coronary Surgery be a Predictor of Mortality? Turk J AnaesthesiolReanim. 2018 Jun; 46(3): 184–190. |
[30] | I. Moursi, K. Al Fakharany. Prognosis of diabetic coronary artery bypass graft surgerypatients. Journal of the Egyptian Society of Cardio-Thoracic Surgery 25 (2017) 294-300. |
[31] | Thourani VH, Weintraub WS, Stein B, et al. Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting. Ann ThoracSurg 1999;67:104552. |
[32] | Szabo Z, Håkanson E, Svedjeholm R, et al. Early postoperative outcome and medium term survival in 540 diabetic and 2239 non diabetic patients undergoing coronary artery bypass grafting. Ann ThoracSurg 2002;74:7129. |
[33] | Rajakaruna C, Rogers CA, Suranimala C. The effect of diabetes mellitus on patients undergoing coronary surgery: a riskeadjusted analysis. J ThoracCardiovascSurg 2006;132. 80210. |
[34] | P. Knapik, D. Ciesla, K. filipiak, M. Knapik, M. Zembala. Prevalence and clinical significance of elevated preoperative glycosylated hemoglobin in diabetic patients scheduled for coronary artery surgery. Eur J CardiothoracSurg, 39 (2011), pp. 484-489. |
[35] | T. Kinoshita, T. Asai, T. Suzuki, A. Kambara, K. Matsubayashi. Preoperative hemoglobin A1c predicts atrial fibrillation after off-pump coronary artery bypass surgery. Eur J CardiothoracSurg, 41 (2012), pp. 102-107. |
[36] | Raza S, Sabik JF, Masabni K, et al. Surgical revascularization techniques that minimize surgical risk and maximize late survival after coronary artery bypass grafting in patients with diabetes mellitus. J ThoracCardiovascSurg 2014;148:1257-66. |
[37] | A. P. Furnary, Y. Wu. Eliminating the diabetic disadvantage: the Portland diabetic project. SeminThoracCardiovascSurg, 18 (2006), pp. 302-308. |
[38] | D. Göksedef, S. Ömeroğlu, E. Yalvaç, M. Bitargil, G. İpek. Is elevated HbA1c a risk factor for infection after coronary artery bypass grafting surgery. Turk J ThoracCardiovascSurg, 18 (2010), pp. 252-258. |
[39] | K. Matsuura, M. Imamaki, A. Ishida, H. Shimura, Y. Niitsuma, M. Miyazaki. Off-pump coronary artery bypass grafting for poorly controlled diabetic patients. Ann ThoracSurg, 15 (2009), pp. 18-22. |
[40] | T. Alserius, R. Anderson, N. Hammar, T. Nordqvist, T. Ivert. Elevated glycosylated haemoglobin (HbA1c) is a risk marker in coronary artery bypass surgery. ScandCardiovasc J, 42 (2008), pp. 392-398. |
[41] | Filsoufi F, Rahmaniana PB, Castillo JG, et al. Diabetes is not a risk factor for hospital mortality following contemporary coronary artery bypass grafting. Interact CardiovascThoracSurg 2007;6:753-8. |
[42] | Leavitt BJ, Sheppard L, Maloney C, et al. Effect of diabetes and associated conditions on long-term survival after coronary artery bypass graft surgery. Circulation 2004;110. II414. |
APA Style
Ahmed Saber Ibrahim Elsayed, Khalid Ragab Abdelsamad Eid. (2019). Tracing the Proposed Adverse Effects of Higher Values of Glycosylated Hemoglobin (HbA1c) in Tightly-Controlled Diabetic Patients Undergoing Primary CABG. International Journal of Cardiovascular and Thoracic Surgery, 5(2), 31-40. https://doi.org/10.11648/j.ijcts.20190502.12
ACS Style
Ahmed Saber Ibrahim Elsayed; Khalid Ragab Abdelsamad Eid. Tracing the Proposed Adverse Effects of Higher Values of Glycosylated Hemoglobin (HbA1c) in Tightly-Controlled Diabetic Patients Undergoing Primary CABG. Int. J. Cardiovasc. Thorac. Surg. 2019, 5(2), 31-40. doi: 10.11648/j.ijcts.20190502.12
AMA Style
Ahmed Saber Ibrahim Elsayed, Khalid Ragab Abdelsamad Eid. Tracing the Proposed Adverse Effects of Higher Values of Glycosylated Hemoglobin (HbA1c) in Tightly-Controlled Diabetic Patients Undergoing Primary CABG. Int J Cardiovasc Thorac Surg. 2019;5(2):31-40. doi: 10.11648/j.ijcts.20190502.12
@article{10.11648/j.ijcts.20190502.12, author = {Ahmed Saber Ibrahim Elsayed and Khalid Ragab Abdelsamad Eid}, title = {Tracing the Proposed Adverse Effects of Higher Values of Glycosylated Hemoglobin (HbA1c) in Tightly-Controlled Diabetic Patients Undergoing Primary CABG}, journal = {International Journal of Cardiovascular and Thoracic Surgery}, volume = {5}, number = {2}, pages = {31-40}, doi = {10.11648/j.ijcts.20190502.12}, url = {https://doi.org/10.11648/j.ijcts.20190502.12}, eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20190502.12}, abstract = {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 values8.6%. 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.}, year = {2019} }
TY - JOUR T1 - Tracing the Proposed Adverse Effects of Higher Values of Glycosylated Hemoglobin (HbA1c) in Tightly-Controlled Diabetic Patients Undergoing Primary CABG AU - Ahmed Saber Ibrahim Elsayed AU - Khalid Ragab Abdelsamad Eid Y1 - 2019/06/05 PY - 2019 N1 - https://doi.org/10.11648/j.ijcts.20190502.12 DO - 10.11648/j.ijcts.20190502.12 T2 - International Journal of Cardiovascular and Thoracic Surgery JF - International Journal of Cardiovascular and Thoracic Surgery JO - International Journal of Cardiovascular and Thoracic Surgery SP - 31 EP - 40 PB - Science Publishing Group SN - 2575-4882 UR - https://doi.org/10.11648/j.ijcts.20190502.12 AB - 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 values8.6%. 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. VL - 5 IS - 2 ER -