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Influence of preoperative hemoglobin A1c on early outcomes in patients with diabetes mellitus undergoing off-pump coronary artery bypass surgery

Authors
 Hye Jin Kim  ;  Jae-Kwang Shim  ;  Young-Nam Youn  ;  Jong-Wook Song  ;  Haeyeon Lee  ;  Young-Lan Kwak 
Citation
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, Vol.159(2) : 568-576, 2020 
Journal Title
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 
ISSN
 0022-5223 
Issue Date
2020
Keywords
diabetes ; glycemic variability ; hemoglobin A1c ; morbidity ; mortality ; off-pump coronary artery bypass surgery
Abstract
OBJECTIVE: There seem to be modifiable components of diabetes in terms of glycemic control to improve surgical outcome. The aim of the study was to evaluate impact of preoperative glycated hemoglobin (HbA1c) level in patients with diabetes mellitus undergoing off-pump coronary bypass (OPCAB) on perioperative glycemic variability and short-term outcome. METHODS: Medical records of 703 patients with diabetes mellitus who underwent OPCAB from 2005 to 2017 were reviewed. The perioperative goal of glycemic control was <180 mg/dL. Patients were divided into 2 groups according to HbA1c level (<7.0% or ≥7.0%). Glycemic variability during surgery and up to 24 hours after surgery was assessed by coefficient of variation (CV). Primary outcome was defined as composite of postoperative permanent stroke, prolonged ventilation, deep sternal wound infection, renal failure, reoperation, and 30-day mortality. RESULTS: Incidence of composite of postoperative morbidity and mortality endpoints was greater in patients with HbA1c ≥7.0% (21% vs 15%, P = .041). Perioperative time-weighted average glucose concentration was also greater in patients with HbA1c ≥7.0%, whereas the CV did not show any difference. Multivariable logistic regression analysis revealed that congestive heart failure, chronic kidney disease, moderate mitral regurgitation or greater, preoperative hemoglobin level, and preoperative HbA1c ≥7.0% were independently associated with composite of postoperative morbidity and mortality, but perioperative CV and time-weighted average glucose ≥200 mg/dL were not. CONCLUSIONS: Increased preoperative HbA1c (≥7.0%) level reflecting long-term glycemic control seems to exert an adverse influence on outcome, whereas the influence of perioperative glycemic variables appear to be abrogated using a target glucose level of <180 mg/dL in patients with diabetes mellitus undergoing OPCAB.
Full Text
https://www.sciencedirect.com/science/article/pii/S0022522319303009
DOI
10.1016/j.jtcvs.2019.01.086
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Kim, Hye Jin(김혜진) ORCID logo https://orcid.org/0000-0003-3452-477X
Song, Jong Wook(송종욱) ORCID logo https://orcid.org/0000-0001-7518-2070
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
Youn, Young Nam(윤영남)
Lee, Haeyeon(이해연) ORCID logo https://orcid.org/0000-0001-8065-9590
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/175314
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