title: Effect of preoperative hemoglobin A1c levels on long-term outcomes for diabetic patients after off-pump coronary artery bypass grafting.
abstract: BACKGROUND
  Diabetes mellitus is an independent risk factor for cardiovascular events after coronary artery bypass grafting (CABG), and hemoglobin A1c (HbA1c) is the most convenient marker for monitoring glycemic control among diabetic patients. However, few studies have reported the impact of baseline HbA1c levels on outcomes for diabetic patients after CABG. This study therefore aimed to investigate whether preoperative HbA1c levels in diabetic patients are predictive of long-term outcomes after off-pump CABG (OPCAB).
  
  
  RESULTS
  Of 893 patients undergoing primary isolated OPCAB at Juntendo University Hospital from July 2002 to December 2007, subjects comprised 306 diabetic patients <80 years old. We divided these patients into 3 groups according to the preoperative HbA1c levels. No significant differences in baseline characteristics, angiographic findings, or operative parameters were apparent among the 3 groups. No operative or in-hospital mortality occurred. All-cause mortality and cardiac mortality rates were 6.2% (19 cases) and 1.3% (4 cases), respectively. Kaplan-Meier's survival showed no significant differences in all-cause or cardiac mortality (log-rank test, p=0.26, p=0.17, respectively). Multivariate analysis by Cox's proportional hazards model also demonstrated that no covariates predicted mortality except for age.
  
  
  CONCLUSIONS
  Preoperative HbA1c levels might not predict long-term outcomes for diabetic patients undergoing OPCAB. Careful evaluation for diabetes should be needed in preoperative management of CABG.
authors.affiliation: Department of Cardiovascular Surgery, Juntendo University, School of Medicine, Tokyo, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Tsuruta
authors.forename: Katsumi
authors.initials: K
authors.lastname: Miyauchi
authors.forename: Taira
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Shizuyuki
authors.initials: S
authors.lastname: Dohi
authors.forename: Keiichi
authors.initials: K
authors.lastname: Tambara
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Dohi
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Inaba
authors.forename: Kenji
authors.initials: K
authors.lastname: Kuwaki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daida
authors.forename: Atsushi
authors.initials: A
authors.lastname: Amano
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D001026:Coronary Artery Bypass; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D048909:Diabetes Complications / Q000175:diagnosis; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011300:Preoperative Care; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human