Abstract
Aims To investigate the effect of preoperative HbA1c levels on the postoperative outcomes of coronary artery disease surgery in diabetic and nondiabetic patients. Methods and Results The MEDLINE (via PubMed), Cochrane Library, Web of Science, Embase, Wanfang Data, China National Knowledge Infrastructure (CNKI), and Chinese Biology Medicine (CBM) databases were used to search the effects of different preoperative HbA1c levels on the postoperative outcomes of coronary artery disease surgical treatment in diabetic and nondiabetic patients from inception to December 2018. Two review authors worked in an independent and duplicate manner to select eligible studies, extract data, and assess the risk of bias of the included studies. We used a meta-analysis to synthesize data and analyze subgroups, sensitivity, and publication bias as well as the GRADE methodology if appropriate. The literature search retrieved 886 records initially, and 23 cohort studies were included in the meta-analysis. In this meta-analysis, we found that there was a reduced incidence of surgical site infections (OR = 2.94, 95% CI 2.18-3.98), renal failure events (OR = 1.63, 95% CI 1.13-2.33), and myocardial infarction events (OR = 1.69, 95% CI 1.16-2.47), as well as a shortened hospital stay (MD = 1.08, 95% CI 0.46-1.71), in diabetic patients after coronary artery disease surgical treatment with lower preoperative HbA1c levels. For nondiabetic patients, a higher preoperative HbA1c level resulted in an increase in the incidence of mortality (OR = 2.23, 95% CI 1.01-4.90) and renal failure (OR = 2.33, 95% CI 1.32-4.12). No significant difference was found between higher and lower preoperative HbA1c levels in the incidence of mortality (OR = 1.06, 95% CI 0.88-1.26), stroke (OR = 1.49, 95% CI 0.94-2.37), or atrial fibrillation (OR = 0.94, 95% CI 0.67-1.33); the length of ICU stay (MD = 0.20, 95% CI -0.14-0.55); or sepsis incidence (OR = 2.49, 95% CI 0.99-6.25) for diabetic patients or for myocardial infarction events (OR = 1.32, 95% CI 0.27-6.31) or atrial fibrillation events (OR = 0.99, 95% CI 0.74-1.33) for nondiabetic patients. The certainty of evidence was judged to be moderate or low. Conclusion This meta-analysis showed that higher preoperative HbA1c levels may potentially increase the risk of surgical site infections, renal failure, and myocardial infarction and reduce the length of hospital stay in diabetic subjects after coronary artery disease surgical treatment and increase the risk of mortality and renal failure in nondiabetic patients. However, there was great inconsistency in defining higher preoperative HbA1c levels in the studies included; we still need high-quality RCTs with a sufficiently large sample size to further investigate this issue in the future. This trial is registered with CRD42019121531.
Highlights
Diabetes mellitus (DM) is a chronic disease with dysfunction in insulin secretion that gradually affects critical organs and tissues, including the heart, nerves, blood vessels, and eyes, and increases the risk of their infection [1]
Our study focused on the impact of preoperative hemoglobin A1c (HbA1c) levels on the postoperative outcomes of coronary artery disease surgical treatment in diabetic and nondiabetic patients, and we conducted a meta-analysis by retrieving and reviewing systematically relevant research evidence
We mainly focused on coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) and ignored the other risk factors that most likely affect the outcomes of elective cardiac surgery, such as cardiovascular risk factors and medical history
Summary
Diabetes mellitus (DM) is a chronic disease with dysfunction in insulin secretion that gradually affects critical organs and tissues, including the heart, nerves, blood vessels, and eyes, and increases the risk of their infection [1]. The International Diabetes Federation reported that 415 million people, i.e., 8.8% of the world population, suffered from DM in 2015 [2]. With 109.6 million people suffering from diabetes, ranked number one in the world. With a sharply rising trend, the number of global diabetic patients and the global prevalence rate are estimated to reach 642 million and 10.4%, respectively, in 2040. The number of diabetic patients in China will reach 150.7 million. Spending on the treatment of DM was estimated to be between 673 and 1197 billon US dollars, which was approximately 11.6% of the total world spending on health. As one of the most important noninfectious diseases, diabetes brings about a heavy burden on patients and their families, societies, and countries in terms of health and economic outcomes
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