Key result
Elevated pre-operative HbA1c was an independent predictor of long-term mortality following coronary artery bypass grafting (HR 5.27; 95% CI 2.53-10.99; p<0.001).
Why the study?
The predictive value of pre-operative HbA1c on outcomes following coronary artery bypass grafting in diabetes patients was assessed to address uncertainty in risk stratification.
Does elevated pre-operative HbA1c predict worse outcomes and long-term mortality in patients undergoing coronary artery bypass grafting?
Cohort
No
Does elevated pre-operative HbA1c predict worse outcomes and long-term mortality in patients undergoing coronary artery bypass grafting?
Hazard Ratio: 5.27 (95% CI 2.53–10.99)
p-value: p=<0.001
Elevated pre-operative HbA1c is a strong independent predictor of long-term mortality and post-operative morbidity in diabetic patients undergoing CABG, justifying pre-operative screening.
Objectives Assess whether pre-operative HbA 1c demonstrates positive predictive value relating to outcomes following coronary artery bypass grafting (CABG) in diabetes patients. Methods Retrospective analysis of outcomes and mortality following CABG; examining the effects of diabetes and HbA 1c . Results Post-operative length of stay (LOS) was prolonged in elective and urgent diabetes patients;7.3 ± 2.1 versus 6.4 ± 1.6 days and 9.0 ± 1.9 versus 7.6 ± 1.8 days, respectively; ( p < 0.001). Sternal and leg wound infection rate was higher in elective diabetes group compared to no-diabetes group; 7% versus 3% ( p < 0.01) and 3% versus 1% ( p < 0.05), respectively. Pneumonia rate increased in elective and urgent diabetes patients; 19% versus 8% ( p < 0.001) and 21% versus 15% ( p < 0.05), respectively. Diabetes increased new-onset atrial fibrillation; 26% versus 14% ( p < 0.001), and doubled blood transfusion rate; 28% versus 14% ( p < 0.001) in elective patients; with similar findings in urgent patients. Long-term mortality was higher with diabetes compared to no-diabetes in elective patients; 15% versus 5%, ( p < 0.001), and urgent patients; 10% versus 2%, ( p < 0.001). Elevated HbA 1c showed significant positive predictive value relating to long-term mortality, and rates of pneumonia, blood transfusion, wound infection in elective and urgent diabetes patients; ( p < 0.001). Elevated HbA 1c was an independent predictor of long-term mortality (hazard ratio:5.27, 95% CI:2.53–10.99; p < 0.001), superficial wound infection (odds ratio (OR):18.23, p < 0.001) and delayed discharge (OR:8.15, p < 0.001). Conclusions Diabetes patients have prolonged LOS and increased morbidity following CABG. HbA 1c is predictive of morbidity and long-term mortality in diabetes patients, and pre-operative HbA 1c screening is justified in all surgical patients.
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Navaratnarajah et al. (2025) conducted a cohort in Coronary artery bypass grafting (CABG). Elevated pre-operative HbA1c vs. Normal or lower HbA1c was evaluated on Long-term mortality (HR 5.27, 95% CI 2.53-10.99, p=<0.001). Elevated pre-operative HbA1c was an independent predictor of long-term mortality following coronary artery bypass grafting (HR 5.27; 95% CI 2.53-10.99; p<0.001).
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