Diabetic control and coronary artery bypass: effect on short-term outcomes

• Published in: Asian cardiovascular & thoracic annals Vol. 21; no. 3; pp. 281 - 287
• Main Authors: Strahan, Stephen, Harvey, Ryan M, Campbell-Lloyd, Andrew, Beller, Elaine, Mundy, Julie, Shah, Pallav
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.06.2013
• Subjects: Biomarkers - blood; Blood Glucose - drug effects; Blood Glucose - metabolism; Comorbidity; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - mortality; Coronary Artery Disease - diagnosis; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Diabetes Mellitus - blood; Diabetes Mellitus - diagnosis; Diabetes Mellitus - drug therapy; Diabetes Mellitus - mortality; Glycated Hemoglobin A - metabolism; Hospital Mortality; Humans; Hypoglycemic Agents - therapeutic use; Insulin - therapeutic use; Prevalence; Queensland - epidemiology; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Blood glucose; postoperative complications; diabetes mellitus; coronary artery bypass; treatment outcome
• DOI: 10.1177/0218492312451983
• ISSN: 0218-4923

Aim:To evaluate the effect of preoperative glycemic control on hospital morbidity and mortality in diabetic patients undergoing primary coronary artery bypass grafting. Methods:Data of 3857 patients undergoing primary coronary artery bypass grafting was prospectively collected and retrospectively analyzed. There were 1109 (29%) diabetic patients, of whom 712 (64%) had hemoglobin A1c levels recorded. They were categorized by diabetic treatment: diet (179), oral hypoglycemic agent, (718) or insulin (212); and by diabetic control: hemoglobin A1c < 7 (265) or ≥7 (447). Nondiabetic patients (2,748) were used as controls. Results:The preoperative risk factors of hypertension (p < 0.001), hyperlipidemia (p < 0.001), renal failure (p < 0.04), peripheral vascular disease (p < 0.001), and chronic obstructive pulmonary disease (p < 0.04) were significantly more prevalent in diabetic patients. Major complications were not significantly different between the diabetic and control groups (p = 0.33), but minor complications were less frequent in diabetic patients (p = 0.03). Major and minor complications were not significantly different among the treatment subgroups of diabetic patients (p = 0.74 and p = 0.48) or in those with hemoglobin A1c < 7 and ≥7 (p = 0.23, p = 0.41). Conclusions:Short-term outcomes were not affected by the degree of preoperative glycemic control or type of treatment used in diabetic patients undergoing primary coronary artery bypass grafting. A plausible explanation is strict protocol-driven glycemic control in the perioperative period.