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. 2014 Jul-Sep;29(3):360-6.
doi: 10.5935/1678-9741.20140105.

Does homeostasis model assessment of insulin resistance have a predictive value for post-coronary artery bypass grafting surgery outcomes?

Ebuzer Aydin  1 , Mehmet Ozkokeli  1
Affiliations

Does homeostasis model assessment of insulin resistance have a predictive value for post-coronary artery bypass grafting surgery outcomes?

Ebuzer Aydin et al. Rev Bras Cir Cardiovasc. 2014 Jul-Sep.

Abstract
in English, Portuguese

Objective: This study aims to investigate whether pre-operative Homeostasis Model Assessment Insulin Resistance (HOMA-IR) value is a predictor in non-diabetic coronary artery bypass grafting patients in combination with hemoglobin A1c, fasting blood glucose and insulin levels.

Methods: Eighty one patients who were admitted to Cardiovascular Surgery Clinic at our hospital between August 2012 and January 2013 with a coronary artery bypass grafting indication were included. Patients were non-diabetic with <6.3% hemoglobin A1c and were divided into two groups including treatment and control groups according to normal insulin resistance (HOMA-IR<2.5, Group A; n=41) and high insulin resistance (HOMA-IR>2.5, Group B; n=40), respectively. Pre-operative fasting blood glucose and insulin were measured and serum chemistry tests were performed. The Homeostasis Model Assessment Insulin Resistance values were calculated. Statistical analysis was performed.

Results: There was a statistically significant difference in fasting blood glucose and HOMA-IR values between the groups. Cross-clamping time, and cardiopulmonary bypass time were longer in Group B, compared to Group A (P=0.043 and P=0.031, respectively). Logistic regression analysis revealed that hemoglobin A1c was not a reliable determinant factor alone for pre-operative glucometabolic evaluation of non-diabetic patients. The risk factors of fasting blood glucose and cardiopulmonary bypass time were more associated with high Homeostasis Model Assessment Insulin Resistance levels.

Conclusion: Our study results suggest that preoperative screening of non-diabetic patients with Homeostasis Model Assessment Insulin Resistance may improve both follow-up visit schedule and short-term outcomes, and may be useful in risk stratification of the high-risk population for impending health problems.

Objetivo: Este estudo tem como objetivo investigar se a resistência de valor do Modelo de Avaliação da Homeostase da Resistência à Insulina (Homeostasis Model Assessment Insulin Resistance - HOMA-IR) no pré-operatório é um preditor de revascularização do miocárdio para pacientes não diabéticos em combinação com a hemoglobina A1c, glicemia em jejum e insulina.

Métodos: Oitenta e um pacientes que foram internados no serviço de Cirurgia Cardiovascular em nosso hospital entre agosto de 2012 e janeiro de 2013, com indicação para cirurgia de revascularização do miocárdio indicação foram incluídos. Os pacientes não diabéticos com <6,3% de hemoglobina A1c foram divididos em dois grupos, incluindo os grupos de tratamento e controle de acordo com a resistência à insulina normal (HOMA-IR <2,5, Grupo A, n=41) e alta resistência à insulina (HOMA-IR> 2,5, Grupo B, n=40), respectivamente. Glicemia de jejum pré-operatório e insulina foram medidas e testes de química do soro foram realizados. Os valores de HOMA-IR foram calculados. A análise estatística foi realizada.

Resultados: Houve diferença estatisticamente significativa em jejum de valores de glicose no sangue e HOMA-IR entre os grupos. Tempo de pinçamento e tempo de circulação extracorpórea foi maior no grupo B, em relação ao Grupo A (P=0,043 e P=0,031, respectivamente). A análise de regressão logística revelou que hemoglobina A1c não foi um fator determinante para a avaliação confiável sozinho glicometabólico pré-operatória de pacientes não diabéticos. Os fatores de risco de glicemia de jejum e tempo de circulação extracorpórea foram associados com altos níveis do HOMA-IR.

Conclusão: Nossos resultados sugerem que a triagem pré-operatória de pacientes não diabéticos utilizando o HOMA-IR pode melhorar tanto o cronograma de acompanhamento quanto resultados de curto prazo, e pode ser útil na estratificação da população de alto risco para iminentes problemas de saúde.

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