Abstract
Aims/Introduction The aim of the present study was to investigate whether HbA1c was related to clinical outcomes in diabetic patients undergoing CABG surgery. Materials and Methods A literature search was carried out satisfying the predefined inclusion criteria from Pubmed, Embase, and Cochrane Library. Differences were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) to assess the relationships of preoperative HbA1c levels and clinical prognosis in diabetic patients. Results 7895 diabetic patients undergoing CABG surgery from eight published studies were finally involved in this meta-analysis. Combined analyses revealed that the higher HbA1c level was significantly associated with increased risks of all-cause mortality (OR 1.56, 95%CI 1.29–1.88), myocardial infarction (OR 2.37, 95%CI 1.21–4.64), and stroke (OR 2.07, 95%CI 1.29–3.32) after CABG surgery. However, there was no significant relationship between HbA1c levels and renal failure (OR 2.08, 95%CI 0.96–4.54) in diabetic patients undergoing CABG surgery. Conclusions Our meta-analysis demonstrated that the HbA1c level is potentially associated with increased risks of all-cause mortality, myocardial infarction, and stroke in diabetic subjects undergoing CABG surgery. However, further clinical studies with larger sample sizes and longer follow-up period are urgently warranted.
Highlights
There has been a marked decline in mortality from cardiovascular disease (CVD) over the past several decades [1]
Diabetes mellitus has long been recognized as an independent risk factor for the development of coronary artery disease [32], and it is associated with a 2- to 4-fold increased risk of cardiovascular disease, with event rates correlating with the degree of hyperglycemia [33]
1% in HbA1c was associated with an increased risk of 18% in cardiovascular disease events [34], 19% in myocardial infarction [34], and 12% to 14% in all-cause mortality [4, 35]
Summary
There has been a marked decline in mortality from cardiovascular disease (CVD) over the past several decades [1]. Epidemiological studies have reported that clinical outcomes after CABG surgery are significantly worse in diabetic patients than in nondiabetic patients [5, 6]. DM increases short-term mortality and morbidity in patients following CABG surgery. The largest study to date by Carson and colleagues examined outcomes in 41,663 diabetic patients compared with those in 105,123 nondiabetic patients and found that patients with diabetes had a 23% to 37% increase in 30-day mortality and in-hospital morbidity compared with patients without diabetes undergoing CABG surgery [7]. DM patients undergoing CABG surgery are more likely to develop postoperative infection and as well as new-onset atrial fibrillation and have worse clinical outcomes than non-DM patients [8]
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