IMPACT OF ELEVATED GLYCOSYLATED HEMOGLOBIN ON HOSPITAL OUTCOME AND 1 YEAR SURVIVAL OF PRIMARY ISOLATED CORONARY ARTERY BYPASS GRAFTING PATIENTS
Mona Ramadan1, Ahmed Abdelgawad2, Ahmed Elshemy2, Emad Sarawy2, Aly Emad2, Mahmoud Mazen2, Ahmed Abdel Aziz MD3
Departments of 1Anesthesia, 2Cardiac Surgery, and 3Cardiology, National Heart Institute
Objective: It is unknown whether adequacy of diabetic control, measured by hemoglobin A1c, is a predictor of adverse outcomes after coronary artery bypass grafting. Methods: From December 2013 to November 2015, 80 consecutive patients underwent primary isolated CABG surgery at national heart institute, their data were prospectively collected and they were classified according to their HbA1c level into two groups, Group (A): Forty patients with fair glycemic control (HbA1c below or equal to 7%), Group (B): Forty patients with poor glycemic control (HbA1c above 7%). Hospital morbidity, mortality and one year survival were examined in both groups. Telephone conversation was used to call patients or their relatives to determine the one year survival and it was 100% complete. This study had gained the ethical approval from national heart institute ethical committee. Results: In-hospital mortality for group A was 2.5% (one patient) and 7.5% (3 patients) for group B with no statistical significance. One year mortality was (5.13%) (2 patients for group A) and (8.11%) (3 patients) for group B with no statistical significance. As regard the morbidity there was no statistical significance between the two groups in the incidence of neurological complications whether stroke or coma, atrial fibrillation, postoperative myocardial infarction, low cardiac output syndrome, heart failure, renal failure, need for dialysis, deep sternal wound infection, and readmission. However, group B had lengthy hospital stay, lengthy ventilation hours, more respiratory complications, and more superficial wound infection with a statistical significance when compared to group A, P values were 0.003, 0.003, 0.038, 0.044 respectively. Conclusions: This study showed that HbA1c is a powerful predictor of in-hospital morbidity. This simple laboratory test drawn preoperatively may provide the clinician with a more accurate risk profile and provide additional prognostic information when discussing morbidity and mortality risks with patients and their families.
December 2016