Abstract 15722: Elevated Preoperative Hemoglobin A1c Level and Adverse Long-term Outcomes After Coronary Artery Bypass Surgery in Patients With Renal Dysfunction and Diabetes
Background: Renal dysfunction (RD) and diabetes are respectively associated with adverse outcomes of patients undergoing coronary artery bypass grafting (CABG). However, among the patients with severe RD who undergo CABG, the impact of diabetes and preoperative hemoglobin A1c (HbA1c) level is not well defined. This study was performed to investigate whether diabetes and higher HbA1c level are associated with long-term adverse outcomes in patients with severe RD undergoing CABG.
Methods: A retrospective review of 963 patients undergoing isolated CABG from 2000 to 2014 at our institution was performed. The estimated glomerular filtration rate (eGFR) was evaluated by the Japanese coefficient for the Modification of Diet in Renal Disease formula. The patients with eGFR less than 30 mL/min/1.73 m2 were defined as severe RD and included in the study. The study patients were divided into groups based on the coexistence of diabetes and the preoperative HbA1c levels: HbA1c less than 7.0% and HbA1c of 7.0% or greater. Major Adverse Cardiovascular and Cerebrovascular Event (MACCE) and all-cause mortality were measured as long-term outcomes. Kaplan-Meier curves and log-rank test were used to estimate long-term outcomes.
Results: A total of 111 patients (11.5%) had severe RD. Of these patients, 79 (71.2%) had diabetes. Of the patients with severe RD and diabetes, HbA1c level was less than 7.0% in 38 patients (48.1%) and equal to or greater than 7.0% in 41 patients (51.9%). 10-year MACCE free rate of patients with severe RD was 33.6% in non-diabetic patients and 31.3 % in diabetic patients (P=.727). Contrastingly, among the patients who had both severe RD and diabetes, 10-year MACCE free rate was 61.5% in those with HbA1c level less than 7.0% and 0% in those with HbA1c level of 7.0% or greater (P=. 013). 10-year survival of patients with severe RD was 36.2% in the non-diabetic group and 43.8 % in diabetic group (P=.632). 10-year survival of the patients who had both severe RD and diabetes was 71.3% in those with HbA1c level less than 7.0% and 0% in those with HbA1c level of 7.0% or greater (P=. 045).
Conclusions: Preoperative HbA1c level of 7.0 % or higher was associated with elevated MACCE occurrence and reduced long-term survival after CABG in the patients who had both severe RD and diabetes.
Author Disclosures: K. Oi: None. T. Mizuno: None. M. Yashima: None. T. Hachimaru: None. E. Nagaoka: None. H. Kuroki: None. D. Tasaki: None. T. Fujiwara: None. M. Takeshita: None. R. Kinoshita: None. H. Arai: None.
- © 2016 by American Heart Association, Inc.