What is the clinical evidence from this study?

Study design: RCT. Population: Coronary artery bypass graft (CABG) surgery (n=92). Intervention: Intravenous exenatide vs. Intravenous insulin therapy. Primary outcome: Highest value of plasma concentration of troponin I measured between 12 and 24 h after ICU admission (MD 0.16, 95% CI -0.25; 0.57, p=0.54).

November 1, 2018Cardiovascular DiabetologyOpen Access

Impact of intravenous exenatide infusion for perioperative blood glucose control on myocardial ischemia-reperfusion injuries after coronary artery bypass graft surgery: sub study of the phase II/III ExSTRESS randomized trial

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Key result

Intravenous exenatide did not significantly reduce plasma troponin I concentrations between 12 and 24 hours postoperatively compared to intravenous insulin in patients undergoing scheduled CABG surgery (MD 0.16, p=0.54).

Population

92 adults > 18 years admitted for elective CABG surgery, median age 69-71, 84-94% male, single-center in…

Comparison

Intravenous exenatide for blood glucose control… vs Intravenous insulin therapy for blood glucose…

Authors

GBGuillaume BeschApple (Israel)APAndréa PerrottiCardiac Surgery LMLucie Salomon du MontLaboratoire d'études sur les monothéismes

Discussion

Member takes

Implication

Does not support exenatide over insulin for myocardial protection in CABG; challenges GLP-1 agonist benefit in cardiac surgery.

Study Design

Type

RCT (n=92)

Blinding

Open-label

Randomization

1:1 ratio, blocks of varying size, stratified by diabetes

Multicenter

Structured PICO

Population

92 adults undergoing scheduled coronary artery bypass graft surgery, randomized to intravenous exenatide or insulin for perioperative blood glucose control, followed for up to 12 months.

Intervention

Intravenous exenatide (1-h bolus of 0.05 µg/min followed by a constant infusion of 0.025 µg/min) for blood glucose control (target range 100–139 mg/dl) during the first 48 h after surgical incision.

Comparator

Intravenous insulin therapy for blood glucose control (target range 100–139 mg/dl) during the first 48 h after surgical incision.

Outcome

Highest value of plasma concentration of troponin I measured

Main Result

Mean Difference: 0.16 (95% CI -0.25–0.57)

Absolute Event Rate: 2.64% vs 3.34%

p-value: p=0.54

Limitations

Sub study of a phase II/III randomized trial, so the mode of administration was not originally designed to evaluate cardioprotective effects
Included patients at low risk of post-operative heart failure
No proper sample size calculation prior to analysis, leading to a lack of statistical power

Cite This Study

Besch et al. (2018) conducted an RCT in Coronary artery bypass graft (CABG) surgery (n=92). Intravenous exenatide vs. Intravenous insulin therapy was evaluated on Highest value of plasma concentration of troponin I measured between 12 and 24 h after ICU admission (MD 0.16, 95% CI -0.25; 0.57, p=0.54). Intravenous exenatide did not significantly reduce plasma troponin I concentrations between 12 and 24 hours postoperatively compared to intravenous insulin in patients undergoing scheduled CABG surgery (MD 0.16, p=0.54).

synapsesocial.com/papers/6a75ccf2756843cacbb22e39 https://doi.org/10.1186/s12933-018-0784-y

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Impact of intravenous exenatide infusion for perioperative blood glucose control on myocardial ischemia-reperfusion injuries after coronary artery bypass graft surgery: sub study of the phase II/III ExSTRESS randomized trial

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Impact of intravenous exenatide infusion for perioperative blood glucose control on myocardial ischemia-reperfusion injuries after coronary artery bypass graft surgery: sub study of the phase II/III ExSTRESS randomized trial

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider