Glycemic control and risk factors for in-hospital mortality and vascular complications after coronary artery bypass grafting in patients with and without preexisting diabetes.
BACKGROUND:The purpose of this study was to investigate risk factors of in-hospital mortality and vascular complications after coronary artery bypass grafting (CABG), particularly the effect of different glycemic control levels on outcomes in patients with and without previous evidence of diabetes.METHODS:A total of 8682 patients with and without previous diabetes undergoing CABG were categorized into strict, moderate, and liberal glucose control groups according to their mean blood glucose control level <7.8 mmol/L, 7.8 to 10.0 mmol/L, and ≥10.0 mmoL/L after in-hospital CABG.RESULTS:The patients with previous diabetes had higher rates of in-hospital mortality (1.3% vs 0.4%, P < .001) and major complications (7.0% vs 4.8%, P < .001) than those without diabetes. Current diabetes was significantly associated with a higher risk of in-hospital mortality (odds ratio [OR] = 3.14, 95% confidence interval [CI] 1.87-5.27) and major complications (OR = 1.49, 95% CI 1.24-1.80), and smoking and higher low-density lipoprotein cholesterol (LDL-C) levels showed similar results. Among patients with previous diabetes, strict glucose control was significantly associated with an increased risk of in-hospital mortality (OR = 8.32, 95% CI 3.95-17.51) compared with moderate glucose control. Nevertheless, among non-previous diabetic patients with stress hyperglycemia, strict glucose control led to a lower risk of major complications (OR = 0.71, 95% CI 0.52-0.98).CONCLUSIONS:Diabetes status, smoking, and LDL-C levels were modifiable risk factors of both in-hospital mortality and major complications after CABG. Strict glucose control was associated with an increased risk of in-hospital mortality among patients with diabetes, whereas it reduced the risk of major complications among non-previous diabetic patients.
