Blood glucose concentration for predicting poor outcomes in patients with and without impaired glucose metabolism undergoing off-pump coronary artery bypass surgery - long-term observational study.
BACKGROUND
Strict glucose control is an everyday practice in the perioperative period. Elevated glucose level has a deleterious impact on clinical results, but a therapeutic target has not been stated yet.


OBJECTIVE
To determine a glucose concentration range affecting long-term outcomes after coronary artery bypass surgery (CABG).


METHODS
This study is a retrospective evaluation of consecutive patients treated in a university hospital in Poland from 2004 to 2008. Patients were divided into 2 groups: an impaired glucose metabolism group (IGM) if they had 1) known DM or 2) perioperative hyperglycaemia defined as ≥ 200 mg/dl; and a non-IGM group. The end point (EP) was all-cause mortality.


RESULTS
One thousand two hundred and eleven patients were covered by the analysis. The observation time was from 01.01.2004 until 01.08.2012. Patients who had maximal glucose concentrations < 242 mg/dl had the lowest mortality risk (EP in 21.1%); a higher risk was noted in the group with glucose concentrations 242-324 mg/dl (EP in 30.8%); and a very high risk was found for the group where glucose concentration was > 324 mg/dl (EP in 44.2%) (p = 0.041). Patients with IGM had a shorter survival at the end of the study (p < 0.001). The longest survival was observed in patients whose maximal glucose level was ≤ 242 mg/dl (p < 0.001) and the minimal glucose concentration was in the range 61-110 mg/dl (p < 0.001).


CONCLUSIONS
Tight glucose concentration control should be performed irrespective of a diabetes diagnosis and proper treatment introduced when necessary. Maximal glucose concentration should be kept < 242 mg/dl, while the minimum should be in the range 60-110 mg/dl.
1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Wojciech
W
Szychta
Department of Cardiac Surgery, 1 Chair of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Franciszek
F
Majstrak
1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Grzegorz
G
Opolski
1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Krzysztof J
KJ
Filipiak
concentration; diabetes; glucose; mortality; off-pump; off-pump coronary artery bypass surgery