title: Impact of perioperative glycemic control strategy on patient survival after coronary bypass surgery.
abstract: BACKGROUND
  Glycemic control in the perioperative period decreases mortality and morbidity, but data are scarce with regard to the effects of glucose control approaches on survival. We assessed long-term survival in patients treated with 2 strategies of glucose control after first-time isolated coronary artery bypass graft.
  
  
  METHODS
  In a previously published trial, patients were prospectively randomized to strict (90-120 mg/dL) or liberal (121-180 mg/dL) glucose control protocols. The aim of this study was to assess long-term data on survival and health-related quality of life based on the original prospective randomized study population.
  
  
  RESULTS
  No differences were found in cumulative survival between the strict (95.5%) and liberal (93.5%) target range groups (log-rank = 0.32, p = 0.57) over a mean follow-up of 40.0 ± 4.4 months. Physical health-related quality of life significantly improved in all patients from baseline to 6 months after surgery (F = 17.73, p < 0.001), and there were no differences in improvement of health-related quality of life between the 2 target range groups (F = 0.15, p = 0.70).
  
  
  CONCLUSIONS
  These results support our previous findings and indicate that a liberal glycemic control strategy after coronary artery bypass leads to survival rates and improvements in health-related quality of life that are similar to those achieved with a strict target range. In addition, the liberal strategy is superior in glucose control and target range management.
authors.affiliation: Cardiac Surgery Research, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia.
authors.forename: A Thomas
authors.initials: AT
authors.lastname: Pezzella
authors.affiliation: Cardiac Surgery Research, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia.
authors.forename: Sari D
authors.initials: SD
authors.lastname: Holmes
authors.affiliation: Cardiac Surgery Research, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia.
authors.forename: Graciela
authors.initials: G
authors.lastname: Pritchard
authors.affiliation: Cardiac Surgery Research, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Speir
authors.affiliation: Cardiac Surgery Research, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia. Electronic address: niv.ad@inova.org.
authors.forename: Niv
authors.initials: N
authors.lastname: Ad
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011788:Quality of Life
chemical_list: D001786:Blood Glucose