Effect of preoperative hemoglobin A1c levels on long-term outcomes for diabetic patients after off-pump coronary artery bypass grafting
Diabetes mellitus is an independent risk factor for cardiovascular events after coronary artery bypass grafting (CABG), and hemoglobin A1c (HbA1c) is the most convenient marker for monitoring glycemic control among diabetic patients. However, few studies have reported the impact of baseline HbA1c le...
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| Published in | Journal of cardiology Vol. 57; no. 2; pp. 181 - 186 |
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| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Netherlands
Elsevier Ltd
01.03.2011
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0914-5087 1876-4738 1876-4738 |
| DOI | 10.1016/j.jjcc.2010.11.003 |
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| Abstract | Diabetes mellitus is an independent risk factor for cardiovascular events after coronary artery bypass grafting (CABG), and hemoglobin A1c (HbA1c) is the most convenient marker for monitoring glycemic control among diabetic patients. However, few studies have reported the impact of baseline HbA1c levels on outcomes for diabetic patients after CABG. This study therefore aimed to investigate whether preoperative HbA1c levels in diabetic patients are predictive of long-term outcomes after off-pump CABG (OPCAB).
Of 893 patients undergoing primary isolated OPCAB at Juntendo University Hospital from July 2002 to December 2007, subjects comprised 306 diabetic patients <80 years old. We divided these patients into 3 groups according to the preoperative HbA1c levels. No significant differences in baseline characteristics, angiographic findings, or operative parameters were apparent among the 3 groups. No operative or in-hospital mortality occurred. All-cause mortality and cardiac mortality rates were 6.2% (19 cases) and 1.3% (4 cases), respectively. Kaplan–Meier's survival showed no significant differences in all-cause or cardiac mortality (log-rank test,
p
=
0.26,
p
=
0.17, respectively). Multivariate analysis by Cox's proportional hazards model also demonstrated that no covariates predicted mortality except for age.
Preoperative HbA1c levels might not predict long-term outcomes for diabetic patients undergoing OPCAB. Careful evaluation for diabetes should be needed in preoperative management of CABG. |
|---|---|
| AbstractList | Diabetes mellitus is an independent risk factor for cardiovascular events after coronary artery bypass grafting (CABG), and hemoglobin A1c (HbA1c) is the most convenient marker for monitoring glycemic control among diabetic patients. However, few studies have reported the impact of baseline HbA1c levels on outcomes for diabetic patients after CABG. This study therefore aimed to investigate whether preoperative HbA1c levels in diabetic patients are predictive of long-term outcomes after off-pump CABG (OPCAB).
Of 893 patients undergoing primary isolated OPCAB at Juntendo University Hospital from July 2002 to December 2007, subjects comprised 306 diabetic patients <80 years old. We divided these patients into 3 groups according to the preoperative HbA1c levels. No significant differences in baseline characteristics, angiographic findings, or operative parameters were apparent among the 3 groups. No operative or in-hospital mortality occurred. All-cause mortality and cardiac mortality rates were 6.2% (19 cases) and 1.3% (4 cases), respectively. Kaplan-Meier's survival showed no significant differences in all-cause or cardiac mortality (log-rank test, p=0.26, p=0.17, respectively). Multivariate analysis by Cox's proportional hazards model also demonstrated that no covariates predicted mortality except for age.
Preoperative HbA1c levels might not predict long-term outcomes for diabetic patients undergoing OPCAB. Careful evaluation for diabetes should be needed in preoperative management of CABG. Diabetes mellitus is an independent risk factor for cardiovascular events after coronary artery bypass grafting (CABG), and hemoglobin A1c (HbA1c) is the most convenient marker for monitoring glycemic control among diabetic patients. However, few studies have reported the impact of baseline HbA1c levels on outcomes for diabetic patients after CABG. This study therefore aimed to investigate whether preoperative HbA1c levels in diabetic patients are predictive of long-term outcomes after off-pump CABG (OPCAB). Of 893 patients undergoing primary isolated OPCAB at Juntendo University Hospital from July 2002 to December 2007, subjects comprised 306 diabetic patients <80 years old. We divided these patients into 3 groups according to the preoperative HbA1c levels. No significant differences in baseline characteristics, angiographic findings, or operative parameters were apparent among the 3 groups. No operative or in-hospital mortality occurred. All-cause mortality and cardiac mortality rates were 6.2% (19 cases) and 1.3% (4 cases), respectively. Kaplan–Meier's survival showed no significant differences in all-cause or cardiac mortality (log-rank test, p = 0.26, p = 0.17, respectively). Multivariate analysis by Cox's proportional hazards model also demonstrated that no covariates predicted mortality except for age. Preoperative HbA1c levels might not predict long-term outcomes for diabetic patients undergoing OPCAB. Careful evaluation for diabetes should be needed in preoperative management of CABG. Summary Background Diabetes mellitus is an independent risk factor for cardiovascular events after coronary artery bypass grafting (CABG), and hemoglobin A1c (HbA1c) is the most convenient marker for monitoring glycemic control among diabetic patients. However, few studies have reported the impact of baseline HbA1c levels on outcomes for diabetic patients after CABG. This study therefore aimed to investigate whether preoperative HbA1c levels in diabetic patients are predictive of long-term outcomes after off-pump CABG (OPCAB). Methods and results Of 893 patients undergoing primary isolated OPCAB at Juntendo University Hospital from July 2002 to December 2007, subjects comprised 306 diabetic patients <80 years old. We divided these patients into 3 groups according to the preoperative HbA1c levels. No significant differences in baseline characteristics, angiographic findings, or operative parameters were apparent among the 3 groups. No operative or in-hospital mortality occurred. All-cause mortality and cardiac mortality rates were 6.2% (19 cases) and 1.3% (4 cases), respectively. Kaplan–Meier's survival showed no significant differences in all-cause or cardiac mortality (log-rank test, p = 0.26, p = 0.17, respectively). Multivariate analysis by Cox's proportional hazards model also demonstrated that no covariates predicted mortality except for age. Conclusions Preoperative HbA1c levels might not predict long-term outcomes for diabetic patients undergoing OPCAB. Careful evaluation for diabetes should be needed in preoperative management of CABG. Diabetes mellitus is an independent risk factor for cardiovascular events after coronary artery bypass grafting (CABG), and hemoglobin A1c (HbA1c) is the most convenient marker for monitoring glycemic control among diabetic patients. However, few studies have reported the impact of baseline HbA1c levels on outcomes for diabetic patients after CABG. This study therefore aimed to investigate whether preoperative HbA1c levels in diabetic patients are predictive of long-term outcomes after off-pump CABG (OPCAB).BACKGROUNDDiabetes mellitus is an independent risk factor for cardiovascular events after coronary artery bypass grafting (CABG), and hemoglobin A1c (HbA1c) is the most convenient marker for monitoring glycemic control among diabetic patients. However, few studies have reported the impact of baseline HbA1c levels on outcomes for diabetic patients after CABG. This study therefore aimed to investigate whether preoperative HbA1c levels in diabetic patients are predictive of long-term outcomes after off-pump CABG (OPCAB).Of 893 patients undergoing primary isolated OPCAB at Juntendo University Hospital from July 2002 to December 2007, subjects comprised 306 diabetic patients <80 years old. We divided these patients into 3 groups according to the preoperative HbA1c levels. No significant differences in baseline characteristics, angiographic findings, or operative parameters were apparent among the 3 groups. No operative or in-hospital mortality occurred. All-cause mortality and cardiac mortality rates were 6.2% (19 cases) and 1.3% (4 cases), respectively. Kaplan-Meier's survival showed no significant differences in all-cause or cardiac mortality (log-rank test, p=0.26, p=0.17, respectively). Multivariate analysis by Cox's proportional hazards model also demonstrated that no covariates predicted mortality except for age.METHODS AND RESULTSOf 893 patients undergoing primary isolated OPCAB at Juntendo University Hospital from July 2002 to December 2007, subjects comprised 306 diabetic patients <80 years old. We divided these patients into 3 groups according to the preoperative HbA1c levels. No significant differences in baseline characteristics, angiographic findings, or operative parameters were apparent among the 3 groups. No operative or in-hospital mortality occurred. All-cause mortality and cardiac mortality rates were 6.2% (19 cases) and 1.3% (4 cases), respectively. Kaplan-Meier's survival showed no significant differences in all-cause or cardiac mortality (log-rank test, p=0.26, p=0.17, respectively). Multivariate analysis by Cox's proportional hazards model also demonstrated that no covariates predicted mortality except for age.Preoperative HbA1c levels might not predict long-term outcomes for diabetic patients undergoing OPCAB. Careful evaluation for diabetes should be needed in preoperative management of CABG.CONCLUSIONSPreoperative HbA1c levels might not predict long-term outcomes for diabetic patients undergoing OPCAB. Careful evaluation for diabetes should be needed in preoperative management of CABG. |
| Author | Tsuruta, Ryo Dohi, Shizuyuki Kuwaki, Kenji Amano, Atsushi Miyauchi, Katsumi Inaba, Hirotaka Tambara, Keiichi Dohi, Tomotaka Yamamoto, Taira Daida, Hiroyuki |
| Author_xml | – sequence: 1 givenname: Ryo surname: Tsuruta fullname: Tsuruta, Ryo organization: Department of Cardiovascular Surgery, Juntendo University, School of Medicine, Tokyo, Japan – sequence: 2 givenname: Katsumi surname: Miyauchi fullname: Miyauchi, Katsumi email: ktmmy@juntendo.ac.jp organization: Department of Cardiovascular Medicine, Juntendo University, School of Medicine, Tokyo, Japan – sequence: 3 givenname: Taira surname: Yamamoto fullname: Yamamoto, Taira organization: Department of Cardiovascular Surgery, Juntendo University, School of Medicine, Tokyo, Japan – sequence: 4 givenname: Shizuyuki surname: Dohi fullname: Dohi, Shizuyuki organization: Department of Cardiovascular Surgery, Juntendo University, School of Medicine, Tokyo, Japan – sequence: 5 givenname: Keiichi surname: Tambara fullname: Tambara, Keiichi organization: Department of Cardiovascular Surgery, Juntendo University, School of Medicine, Tokyo, Japan – sequence: 6 givenname: Tomotaka surname: Dohi fullname: Dohi, Tomotaka organization: Department of Cardiovascular Medicine, Juntendo University, School of Medicine, Tokyo, Japan – sequence: 7 givenname: Hirotaka surname: Inaba fullname: Inaba, Hirotaka organization: Department of Cardiovascular Surgery, Juntendo University, School of Medicine, Tokyo, Japan – sequence: 8 givenname: Kenji surname: Kuwaki fullname: Kuwaki, Kenji organization: Department of Cardiovascular Surgery, Juntendo University, School of Medicine, Tokyo, Japan – sequence: 9 givenname: Hiroyuki surname: Daida fullname: Daida, Hiroyuki organization: Department of Cardiovascular Medicine, Juntendo University, School of Medicine, Tokyo, Japan – sequence: 10 givenname: Atsushi surname: Amano fullname: Amano, Atsushi organization: Department of Cardiovascular Surgery, Juntendo University, School of Medicine, Tokyo, Japan |
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| Snippet | Diabetes mellitus is an independent risk factor for cardiovascular events after coronary artery bypass grafting (CABG), and hemoglobin A1c (HbA1c) is the most... Summary Background Diabetes mellitus is an independent risk factor for cardiovascular events after coronary artery bypass grafting (CABG), and hemoglobin A1c... |
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| SubjectTerms | Age Factors Aged Biomarkers - blood Cardiovascular Coronary Artery Bypass Coronary Artery Bypass, Off-Pump Coronary Artery Disease - complications Coronary Artery Disease - mortality Coronary Artery Disease - surgery Diabetes Complications - diagnosis Diabetes mellitus Female Glycated Hemoglobin A - analysis Hemoglobin A1c Humans Male Middle Aged Multivariate Analysis Off-pump coronary artery bypass grafting Preoperative Care Risk Factors Time Factors Treatment Outcome |
| Title | Effect of preoperative hemoglobin A1c levels on long-term outcomes for diabetic patients after off-pump coronary artery bypass grafting |
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