Nicolini F, et al. - Experts evaluated if increased baseline HbA1c levels could impact postoperative outcomes other than sternal wound infection (SWI) after coronary artery bypass grafting (CABG). In a significant share of patients undergoing elective CABG, there is increased HbA1c. These patients were at higher risk of SWI, however the impact of HbA1c on other postoperative outcomes was less clear. Screening of HbA1c in patients without history of diabetes was not supported by the findings. Identifying diabetics at risk of SWI was the only real usefulness of preoperative screening of HbA1c.

Methods

• Authors collected data on preoperative levels of HbA1c from 2,606 patients who underwent elective isolated CABG from 2015 to 2016 and were included in the prospective, multicenter E-CABG registry.

Results

• Findings suggested that the prevalence of HbA1c ≥53 mmol/mol (7.0%) in non-diabetics was 5.3%, in non-insulin dependent diabetics was 53.5% and in insulin dependent diabetics was 67.1% (p < 0.001).
• Researchers noted the prevalence of HbA1c > 75 mmol/mol (9.0%) among non-diabetics to be 0.5%, among non-insulin dependent diabetics to be 5.8% and among insulin dependent diabetics to be 10.6% (p < 0.001).
• A significant predictor of any SWI (10.7% vs 3.3%, adjusted p-value: <0.001), deep SWI/mediastinitis (3.8% vs 1.3%, adjusted p-value: 0.001) and acute kidney injury (27.4% vs 19.8%, adjusted p-value: 0.042) was baseline levels of HbA1c ≥53 mmol/mol (7.0%).
• They confirmed these findings in multilevel mixed effect logistic regression adjusted for participating centers.
• HbA1c ≥ 53 mmol/mol (7.0%) was predictive of SWI (11.1% vs 4.8%, p=0.001) among patients with diabetes.