Increased Glucose Variability Is Associated With Major Adverse Events After Coronary Artery Bypass

Kathleen C. Clement, Alejandro Suarez-Pierre, Krisztian Sebestyen, Diane Alejo, Joseph DiNatale, Glenn J.R. Whitman, Thomas L. Matthew, Jennifer S. Lawton

Research output: Contribution to journalArticle

Abstract

Background: Elevated preoperative hemoglobin A1c (HbA1c) is a predictor of poor outcomes after coronary artery bypass grafting (CABG), but the role of postoperative glucose variability (GV) is unknown. We hypothesized that short-term postoperative GV is associated with major adverse events (MAEs) after isolated CABG. Methods: This retrospective study evaluated 2215 patients who underwent isolated CABG from January 2012 to March 2018 at 2 medical centers. Postoperative GV in the first 12 hours and 24 hours was measured by the SD, coefficient of variation, and mean amplitude of glycemic excursions. The primary outcome (MAEs) was the composite of postoperative cardiac arrest, pneumonia, renal failure, stroke, sepsis, reoperation, and 30-day mortality. Multivariate logistic regression assessed the independent association of GV with MAE. Results: A total of 2215 patients met the study criteria, and an MAE developed in 260 patients (11.7%). High 12-hour and 24-hour postoperative GV were associated with elevated HbA1c, insulin-dependent diabetes, renal failure, and nonelective operation. Multivariate logistic regression analysis showed MAEs were associated with increased mean postoperative glucose in the first 12 hours (odds ratio [OR], 1.013; 95% confidence interval [CI], 1.008-1.018; P < .001), the first 24 hours (OR, 1.017; 95% CI, 1.010-1.024; P < .001), and 24-hour postoperative GV (OR, 1.22; 95% CI, 1.09-1.37; P < .001). MAEs were not associated with preoperative HbA1c or 12-hour postoperative GV. Conclusions: Increased 24-hour but not 12-hour postoperative GV after CABG is a predictor of poor outcomes. Preoperative HbA1c is not associated with MAEs after adjusting for postoperative mean glucose and GV.

Original languageEnglish (US)
Pages (from-to)1307-1313
Number of pages7
JournalAnnals of Thoracic Surgery
Volume108
Issue number5
DOIs
StatePublished - Nov 2019

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Coronary Artery Bypass
Glucose
Hemoglobins
Odds Ratio
Confidence Intervals
Renal Insufficiency
Logistic Models
Heart Arrest
Reoperation
Sepsis
Pneumonia
Retrospective Studies
Stroke
Regression Analysis
Insulin
Mortality

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Increased Glucose Variability Is Associated With Major Adverse Events After Coronary Artery Bypass. / Clement, Kathleen C.; Suarez-Pierre, Alejandro; Sebestyen, Krisztian; Alejo, Diane; DiNatale, Joseph; Whitman, Glenn J.R.; Matthew, Thomas L.; Lawton, Jennifer S.

In: Annals of Thoracic Surgery, Vol. 108, No. 5, 11.2019, p. 1307-1313.

Research output: Contribution to journalArticle

Clement, Kathleen C. ; Suarez-Pierre, Alejandro ; Sebestyen, Krisztian ; Alejo, Diane ; DiNatale, Joseph ; Whitman, Glenn J.R. ; Matthew, Thomas L. ; Lawton, Jennifer S. / Increased Glucose Variability Is Associated With Major Adverse Events After Coronary Artery Bypass. In: Annals of Thoracic Surgery. 2019 ; Vol. 108, No. 5. pp. 1307-1313.
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abstract = "Background: Elevated preoperative hemoglobin A1c (HbA1c) is a predictor of poor outcomes after coronary artery bypass grafting (CABG), but the role of postoperative glucose variability (GV) is unknown. We hypothesized that short-term postoperative GV is associated with major adverse events (MAEs) after isolated CABG. Methods: This retrospective study evaluated 2215 patients who underwent isolated CABG from January 2012 to March 2018 at 2 medical centers. Postoperative GV in the first 12 hours and 24 hours was measured by the SD, coefficient of variation, and mean amplitude of glycemic excursions. The primary outcome (MAEs) was the composite of postoperative cardiac arrest, pneumonia, renal failure, stroke, sepsis, reoperation, and 30-day mortality. Multivariate logistic regression assessed the independent association of GV with MAE. Results: A total of 2215 patients met the study criteria, and an MAE developed in 260 patients (11.7{\%}). High 12-hour and 24-hour postoperative GV were associated with elevated HbA1c, insulin-dependent diabetes, renal failure, and nonelective operation. Multivariate logistic regression analysis showed MAEs were associated with increased mean postoperative glucose in the first 12 hours (odds ratio [OR], 1.013; 95{\%} confidence interval [CI], 1.008-1.018; P < .001), the first 24 hours (OR, 1.017; 95{\%} CI, 1.010-1.024; P < .001), and 24-hour postoperative GV (OR, 1.22; 95{\%} CI, 1.09-1.37; P < .001). MAEs were not associated with preoperative HbA1c or 12-hour postoperative GV. Conclusions: Increased 24-hour but not 12-hour postoperative GV after CABG is a predictor of poor outcomes. Preoperative HbA1c is not associated with MAEs after adjusting for postoperative mean glucose and GV.",
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T1 - Increased Glucose Variability Is Associated With Major Adverse Events After Coronary Artery Bypass

AU - Clement, Kathleen C.

AU - Suarez-Pierre, Alejandro

AU - Sebestyen, Krisztian

AU - Alejo, Diane

AU - DiNatale, Joseph

AU - Whitman, Glenn J.R.

AU - Matthew, Thomas L.

AU - Lawton, Jennifer S.

PY - 2019/11

Y1 - 2019/11

N2 - Background: Elevated preoperative hemoglobin A1c (HbA1c) is a predictor of poor outcomes after coronary artery bypass grafting (CABG), but the role of postoperative glucose variability (GV) is unknown. We hypothesized that short-term postoperative GV is associated with major adverse events (MAEs) after isolated CABG. Methods: This retrospective study evaluated 2215 patients who underwent isolated CABG from January 2012 to March 2018 at 2 medical centers. Postoperative GV in the first 12 hours and 24 hours was measured by the SD, coefficient of variation, and mean amplitude of glycemic excursions. The primary outcome (MAEs) was the composite of postoperative cardiac arrest, pneumonia, renal failure, stroke, sepsis, reoperation, and 30-day mortality. Multivariate logistic regression assessed the independent association of GV with MAE. Results: A total of 2215 patients met the study criteria, and an MAE developed in 260 patients (11.7%). High 12-hour and 24-hour postoperative GV were associated with elevated HbA1c, insulin-dependent diabetes, renal failure, and nonelective operation. Multivariate logistic regression analysis showed MAEs were associated with increased mean postoperative glucose in the first 12 hours (odds ratio [OR], 1.013; 95% confidence interval [CI], 1.008-1.018; P < .001), the first 24 hours (OR, 1.017; 95% CI, 1.010-1.024; P < .001), and 24-hour postoperative GV (OR, 1.22; 95% CI, 1.09-1.37; P < .001). MAEs were not associated with preoperative HbA1c or 12-hour postoperative GV. Conclusions: Increased 24-hour but not 12-hour postoperative GV after CABG is a predictor of poor outcomes. Preoperative HbA1c is not associated with MAEs after adjusting for postoperative mean glucose and GV.

AB - Background: Elevated preoperative hemoglobin A1c (HbA1c) is a predictor of poor outcomes after coronary artery bypass grafting (CABG), but the role of postoperative glucose variability (GV) is unknown. We hypothesized that short-term postoperative GV is associated with major adverse events (MAEs) after isolated CABG. Methods: This retrospective study evaluated 2215 patients who underwent isolated CABG from January 2012 to March 2018 at 2 medical centers. Postoperative GV in the first 12 hours and 24 hours was measured by the SD, coefficient of variation, and mean amplitude of glycemic excursions. The primary outcome (MAEs) was the composite of postoperative cardiac arrest, pneumonia, renal failure, stroke, sepsis, reoperation, and 30-day mortality. Multivariate logistic regression assessed the independent association of GV with MAE. Results: A total of 2215 patients met the study criteria, and an MAE developed in 260 patients (11.7%). High 12-hour and 24-hour postoperative GV were associated with elevated HbA1c, insulin-dependent diabetes, renal failure, and nonelective operation. Multivariate logistic regression analysis showed MAEs were associated with increased mean postoperative glucose in the first 12 hours (odds ratio [OR], 1.013; 95% confidence interval [CI], 1.008-1.018; P < .001), the first 24 hours (OR, 1.017; 95% CI, 1.010-1.024; P < .001), and 24-hour postoperative GV (OR, 1.22; 95% CI, 1.09-1.37; P < .001). MAEs were not associated with preoperative HbA1c or 12-hour postoperative GV. Conclusions: Increased 24-hour but not 12-hour postoperative GV after CABG is a predictor of poor outcomes. Preoperative HbA1c is not associated with MAEs after adjusting for postoperative mean glucose and GV.

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