Does HbA1c Level Have Clinical Implications in Diabetic Patients Undergoing Coronary Artery Bypass Grafting? A Systematic Review and Meta-Analysis

Q: What are the key findings of this study?

Higher preoperative HbA1c levels (>7%) were significantly associated with an increased risk of all-cause mortality (OR 1.56) in diabetic patients undergoing CABG surgery.

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Diabetes mellitus undergoing CABG surgery (n=7895). Intervention: Higher preoperative HbA1c level vs. Optimal glycemic control (HbA1c ≤ 7% or similar threshold). Primary outcome: All-cause mortality (OR 1.56, 95% CI 1.29-1.88, p=<0.001).

Q: What does this research mean for the field?

Higher preoperative HbA1c levels are significantly associated with increased risks of all-cause mortality, myocardial infarction, and stroke in diabetic patients undergoing coronary artery bypass grafting. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess whether preoperative HbA1c levels are associated with clinical outcomes in diabetic patients undergoing coronary artery bypass grafting (CABG) surgery.

Jia Zheng; Jing Cheng; Tong Wang; Qian Zhang; Xinhua Xiao

doi:10.1155/2017/1537213

January 1, 2017International Journal of EndocrinologyOpen Access

Does HbA1c Level Have Clinical Implications in Diabetic Patients Undergoing Coronary Artery Bypass Grafting? A Systematic Review and Meta-Analysis

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Key result

Preoperative HbA1c over 7% is linked to ~56% higher all-cause mortality after CABG.

OR 1.56
95% CI 1.29-1.88
P<0.001
n=7,895

Figures

Why the study?

Does higher preoperative HbA1c level increase adverse clinical outcomes in diabetic patients undergoing CABG surgery?

Key Points

To assess whether preoperative HbA1c levels are associated with clinical outcomes in diabetic patients undergoing coronary artery bypass grafting (CABG) surgery.
Searched PubMed, Embase, and Cochrane Library databases based on predefined inclusion criteria.
Identified and pooled data from 8 published studies encompassing 7895 diabetic patients across seven countries (Canada, United States, Poland, Sweden, Argentina, Iran, and Japan).
Calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate the association between preoperative HbA1c levels and postoperative adverse outcomes.
Higher HbA1c level was significantly associated with increased risks of all-cause mortality (OR 1.56, 95% CI 1.29–1.88, p < 0.001), myocardial infarction (OR 2.37, 95% CI 1.21–4.64, p = 0.01), and stroke (OR 2.07, 95% CI 1.29–3.32, p = 0.003).
No significant relationship was observed between higher HbA1c levels and postoperative renal failure (OR 2.08, 95% CI 0.96–4.54, p = 0.06).

Study Design

Type

Meta-Analysis (n=7,895)

Multicenter

Yes

Structured PICO

Does higher preoperative HbA1c level increase adverse clinical outcomes in diabetic patients undergoing CABG surgery?

P

Population

7,895 diabetic patients undergoing coronary artery bypass grafting (CABG) surgery pooled from 8 observational studies.

E

Exposure

Suboptimal glycemic control (preoperative HbA1c > 7% in most included studies)

C

Comparator

Optimal glycemic control (preoperative HbA1c ≤ 7% in most included studies)

O

Outcome

All-cause mortalityhard clinical

Main Result

Odds Ratio: 1.56 (95% CI 1.29–1.88)

p-value: p=<0.001

Preoperative HbA1c >7% is a significant predictor of mortality, MI, and stroke in diabetic patients undergoing CABG, supporting the importance of long-term glycemic control prior to revascularization.

Limitations

Limited total numbers of cases and controls
Potential confounders like ejection fraction and comorbidities not adjusted in several studies
Relatively short follow-up durations
English language restriction may cause publication bias
Observational nature of included studies
Limited total numbers of cases and controls in included studies
Confounders such as ejection fraction, coronary atherosclerosis, and comorbidities not adjusted for in several studies
Languages restricted to English causing potential publication bias

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Answers are grounded in this paper and cite their sources.

Implication

Higher preoperative HbA1c may stratify mortality risk in diabetic CABG patients; extends observational meta-analyses but leaves causal benefit open.

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.

Discussion

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Cite This Study

Zheng et al. (2017) conducted a meta-analysis in Diabetes mellitus undergoing CABG surgery (n=7,895). Higher preoperative HbA1c level vs. Optimal glycemic control (HbA1c ≤ 7% or similar threshold) was evaluated on All-cause mortality (OR 1.56, 95% CI 1.29-1.88, p=<0.001). Higher preoperative HbA1c levels (>7%) were significantly associated with an increased risk of all-cause mortality (OR 1.56) in diabetic patients undergoing CABG surgery.

synapsesocial.com/papers/6a6577d33112dd38a1f0ced0 https://doi.org/10.1155/2017/1537213

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Does HbA1c Level Have Clinical Implications in Diabetic Patients Undergoing Coronary Artery Bypass Grafting? A Systematic Review and Meta-Analysis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Does HbA1c Level Have Clinical Implications in Diabetic Patients Undergoing Coronary Artery Bypass Grafting? A Systematic Review and Meta-Analysis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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