The Effect of HbA1c Level on Gender-Specific Long-Term Morbidity and Mortality After Isolated Coronary Bypass in Poorly Controlled Diabetic Patients

Year 2021, Volume: 11 Issue: 1, 34 - 41, 31.03.2021

Rezan Aksoy Taylan Adademir Deniz Çevirme Ekrem Yilmaz Mehmet Sengor Cengiz Köksal Murat Rabus

https://doi.org/10.33808/clinexphealthsci.782816

Abstract

Objective: The aim of this study is to evaluate the gender specific effects of the high HbA1c levels in poorly controlled diabetic patients undergoing isolated coronary artery bypass grafting (CABG) procedure on long term morbidity, mortality and re-revascularization (2nd intervention).

Methods: This study was conducted on 532 (346 (65%) males and 186 (35%) females) diabetic patients who underwent CABG procedure at a single center between January 2010 and December 2013.The patients were separated into 4 groups according to gender and preoperative HbA1c level (%). The group1 consisted of females with HBA1c level ≤7(n=46); the group 2 comprised female with HbA1c level >7(n=140); the group 3 comprised men with HbA1c level ≤7(n=117); and the group 4 comprised men with HbA1c level >7(n=229). The groups were analyzed and compared for postoperative complications and mortality.

Results: No statistically significant difference was found among the groups in HbA1c levels and gender with respect to postoperative infection and mortality (p>0.05). The HbA1c level was determined to be statically significant and required the 2ndintervention (p:0.001; 95% CI: 1.249 (1.055,1.478)).

Conclusion: This study suggested that there was no difference in mortality rates after CABG among the groups although the current risk calculator modules stated otherwise. However, the HbA1c levels were associated with a need for a secondary intervention on long term follow up period.

Keywords

diabetes mellitus, gender, coronary artery bypass graft

References

• 1. Szabo Z, Hakanson E, Svedjeholm R. Early postoperative outcome and medium-term survival in 540 diabetic and 2239 non diabetic patients undergoing coronary artery bypass grafting. Ann ThoracSurg 2002;74:712-9).
• 2. Thourani VH, Weintraub WS, Stein B, Gebhart SSP, Craver JM, Ellis LJ et al. Influence of diabetes mellitus on early and late outcame after coronary artery bypass grafting. Ann ThoracSurg 1999;67:1045-52.
• 3. Carson JL, Scholz PM, Chen AY, Peterson ED, Gold J, Schneider SH. Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery. J Am CollCardiol 2002;40:418-23
• 4. Haffner SM. Coronary heart disease in patients with diabetes. N Engl J Med 2000;342:1040-2
• 5. Ikeda F, Doi Y, Ninomiya T, Hirakawa Y, Mukai N, Hata J, et al. Haemoglobin A1c evenwithinnon-diabeticlevel is a predictor of cardiovasculardisease in a general Japanesepopulation: theHisayamaStudy. CardiovascDiabetol. 2013;12:164.
• 6. Natali A, Vichi S, Landi P, Severi S, L’Abbate A, Ferrannini E. Coronary atherosclerosis in type II diabetes: angiographic findings and clinical outcome. Diabetologia 2000;43:632-41
• 7. Zheng, J., Cheng, J., Wang, T., Zhang, Q., & Xiao, X. Does HbA1c level have clinical implications in diabetic patients undergoing coronary artery bypass grafting? A systematic review and meta-analysis. International Journal of Endocrinology, 2017. Artcile ID 1537213,8 page
• 8. Faritous Z, Ardeshiri M, Yazdanian F, Jalali A, Totonchi Z, Azarfarin R. Hyperglycemiaor High Hemoglobin A1C: WhichOne is More Associated with Morbidity and Mortality after Coronary Artery Bypass Graft Surgery? AnnThorac CardiovascSurg 2014; 20: 223–228
• 9. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012;2:1–138.
• 10. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS, GOLD Scientific Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary.Am J Respir Crit Care Med. 2001 Apr; 163(5):1256-76.
• 11. Genuth S, Alberti KG, Bennett P, Buse J, Defronzo R, Kahn R, et al. Follow-up report on the diagnosis of diabetes mellitus. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes care. 2003 Nov;26(11):3160-7.
• 12. Catapano, A. L., Graham, I., De Backer, G., Wiklund, O., Chapman, M. J., Drexel, H., et all . 2016 ESC/EAS guidelines for the management of dyslipidaemias. European heart journal, 37(39), 2999-3058.
• 13. Furnary AP, Wu Y, Bookin SO. Effect of hyperglycemia and continuous intravenous insulin infusions on outcomes of cardiac surgical procedures: the Portland Diabetic Project. EndocrPract 2004;10Suppl 2:21-33.
• 14. Lazar HL. How important is glycemic control during coronary artery bypass? AdvSurg 2012;46:219-35.
• 15. The Bypass Angioplasty Revascularization Investigation (BARI) Investigators. Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. N Engl J Med 1996;335:217–225.Erratum, N Engl J Med 1997;336:147.
• 16. Malmberg K, Yusuf S, Gerstein HC, Brown J, Zhao F, Hunt D, et al. Impact of diabetes on long-term prognosis in patients with unstable angina and non–Q-wave myocardial infarction: results of the OASIS (Organization to Assess Strategies for Ischemic Syndromes) Registry. Circulation. 2000 Aug 29;102(9):1014-9.
• 17. Melidonis A, Dimopoulos V, Lempidakis E, Hatzissavas J, Kouvaras G, Stefanidis A, et al. Angiographic study of coronary artery disease in diabetic patients in comparison with nondiabetic patients. Angiology 1999;50:997-1006
• 18. Abaci A, Oğuzhan A, Kahraman S, Eryol NK, Unal S, Arinç H, et al. Effect of diabetes mellitus on formation of coronary collateral vessels. Circulation 1999;99:2239-42
• 19. Czech B, Kucewicz-Czech E, Pacholewicz J, Wojarski J, Puzio J, Przybylski R, et al. Original article Early results of coronary artery bypass graft surgery in women. KardiologiaPolska (Polish Heart Journal). 2007;65(6):627-33
• 20. Göksedef D, Ömeroğlu S, Balkanay O, Talas Z, Arapi B, Ipek G. Coronary artery bypass in women: what is really different?. Turk GogusKalpDama 2012;20:8-13
• 21. Rosamond W, Flegal K, Friday G, Furie K, Go A, GreenlundK,et al. Heart disease and stroke statistics-2007 update;a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2007;115:e169-e171
• 22. Marco SB, Kim MF, Silvia GP. Cardiovascular diseases in Women:a statement from the policy conference of the European Society of Cardiology European Heart Journal 2006; 27:994-1005.
• 23. Kaya M, İyigün T, İyigün M, Bakır İ, Yeniterzi M. The results of coronary artery surgery in women and men under the age of 45.Turk GogusKalpDama 2013;21(3):581-7
• 24. Blankstein R, Parker Ward R, Arnsdorf M, , Jones B, Lou YB, Pine M et al. Female Gender Is an Independent Predictor of Operative Mortality After Coronary Artery Bypass Graft Surgery Contemporary Analysis of 31 Midwestern Hospitals Circulation. 2005; 112 [suppl]:I-323–I-327
• 25. Ennker IC, Albert A, Pietrowski D, Bauer K, Ennker J, Florath I. Impact of gender on outcome after coronary artery bypass surgery. Asian CardiovascThorac Ann 2009;17:253- 8
• 26. Kuhl J, Sartipy U, Eliasson B, Nystrom 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. Halkos M, Lattouf O, Puskas J, Kilgo P, Cooper W, Morris C et al. Elevatedpreoperative hemoglobin A1c level is associatedwithreducedlong-termsurvivalafterartery bypass surgery. AnnThoracSurg 2008;86: 1431–7.
• 28. Michael P. Robich, MD, MSPH, Alexander Iribarne, MD, MS, Bruce J. Leavitt, MD, David J. Malenka, MD, Reed D. Quinn, MD, Elaine M. Olmstead, et all. Intensity of Glycemic Control Affects Long-Term Survival After Coronary Artery Bypass Graft Surgery. Ann ThoracSurg 2019;107:477–85)
• 29. Nystrom T, Holzmann MJ, Eliasson B, Kuhl J, Sartipy U. Glycemic control in type 1 diabetes and long-term risk of cardiovascular events or death after coronary artery bypass grafting. J Am Coll Cardiol 2015;66:535–43.
• 30. Gozdzik, A., Letachowicz, K., Grajek, B. B., Plonek, T., Obremska, M., Jasinski, M., &Gozdzik, W. (2019). Application of strain and other echocardiographic parameters in the evaluation of early and long-term clinical outcomes after cardiac surgery revascularization. BMC cardiovascular disorders, 19(1), 189.
• 31. Cihan HB, Erdil N, Nisanoğlu N, Çolak C, Erdil F, EgeE,et al. Does Type II Diabetes Mellitus Increase Mortality And Morbidity In Coronary Artery Bypass Surgery? Turkish J ThoracCardiovascSurg 2005;13:93-98
• 32. Nicolini, F., Santarpino, G., Gatti, G., Reichart, D., Onorati, F., Faggian, et all. Utility of glycated hemoglobin screening in patients undergoing elective coronary artery surgery: Prospective, cohort study from the E-CABG registry. International Journal of Surgery, 2018, 53, 354-359
• 33. Kocogulları CU, TekeliKunt A, Aksoy R, Duzyol C, Parlar H, Saskın H, et al. Hemoglobin A1c Levels Predicts Acute Kidney Injury after Coronary Artery Bypass Surgery in Non-DiabeticPatients. Braz J CardiovascSurg 2017;32(1):77-83
• 34. Hertzberg D, Sartipy U, Holzmann MJ. Type 1 and type 2 diabetes mellitus and risk of acute kidney injury after coronary artery bypass grafting. American heart journal. 2015 Nov 1;170(5):895-902.