Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar 18:14:20480040251325918.
doi: 10.1177/20480040251325918. eCollection 2025 Jan-Dec.

Effect of glycaemic control on coronary artery bypass grafting outcomes - a United Kingdom centre experience

Manoraj Navaratnarajah  1 , Fadi Ibrahim Al-Zubaidi  1 , Hassan Kattach  1 , Clifford Barlow  1 , Geoff Tsang  1 , Sunil Ohri  1
Affiliations

Effect of glycaemic control on coronary artery bypass grafting outcomes - a United Kingdom centre experience

Manoraj Navaratnarajah et al. JRSM Cardiovasc Dis. .

Abstract

Objectives: Assess whether pre-operative HbA1c demonstrates positive predictive value relating to outcomes following coronary artery bypass grafting (CABG) in diabetes patients.

Methods: Retrospective analysis of outcomes and mortality following CABG; examining the effects of diabetes and HbA1c.

Results: Post-operative length of stay (LOS) was prolonged in elective and urgent diabetes patients;7.3 ± 2.1 versus 6.4 ± 1.6 days and 9.0 ± 1.9 versus 7.6 ± 1.8 days, respectively; (p < 0.001). Sternal and leg wound infection rate was higher in elective diabetes group compared to no-diabetes group; 7% versus 3% (p < 0.01) and 3% versus 1% (p < 0.05), respectively. Pneumonia rate increased in elective and urgent diabetes patients; 19% versus 8% (p < 0.001) and 21% versus 15% (p < 0.05), respectively. Diabetes increased new-onset atrial fibrillation; 26% versus 14% (p < 0.001), and doubled blood transfusion rate; 28% versus 14% (p < 0.001) in elective patients; with similar findings in urgent patients. Long-term mortality was higher with diabetes compared to no-diabetes in elective patients; 15% versus 5%, (p < 0.001), and urgent patients; 10% versus 2%, (p < 0.001). Elevated HbA1c showed significant positive predictive value relating to long-term mortality, and rates of pneumonia, blood transfusion, wound infection in elective and urgent diabetes patients; (p < 0.001). Elevated HbA1c was an independent predictor of long-term mortality (hazard ratio:5.27, 95% CI:2.53-10.99; p < 0.001), superficial wound infection (odds ratio (OR):18.23, p < 0.001) and delayed discharge (OR:8.15, p < 0.001).

Conclusions: Diabetes patients have prolonged LOS and increased morbidity following CABG. HbA1c is predictive of morbidity and long-term mortality in diabetes patients, and pre-operative HbA1c screening is justified in all surgical patients.

Keywords: CABG; Diabetes; HbA1c.

PubMed Disclaimer

Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
HbA1c > 48 mmol/mol (>6.5%) was associated with increased long-term mortality, but not 30-day mortality risk.
Figure 2.
Figure 2.
HbA1c > 48 mmol/mol (>6.5%) was associated with decreased survival following elective CABG (p < 0.001). Median follow-up time:1477 days. CABG: coronary artery bypass grafting.
Figure 3.
Figure 3.
HbA1c > 48 mmol/mol (>6.5%) was associated with increased rate of post-operative pneumonia and blood transfusion.
Figure 4.
Figure 4.
HbA1c > 48 mmol/mol (>6.5%) was associated with increased rate of sternal wound infection.
Figure 5.
Figure 5.
Mean HbA1c and induction BM were elevated in diabetes and newly diagnosed diabetes groups compared with pre-diabetes group (a,b). LOS and superficial sternal wound infection rate were greatest in newly diagnosed diabetes group (c,d). BM: blood glucose; LOS: length of stay.
Figure 6.
Figure 6.
Rates of new POAF, pneumonia, transfusion and delayed discharge were greatest in newly diagnosed diabetes group, compared with pre-diabetes and diabetes groups (a–d). POAF: post-operative atrial fibrillation.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Kondapally R, Seshasai S, Kaptoge S, et al. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med 2011; 364: 829–841. - PMC - PubMed
    1. Gregg EW, Buckley J, Ali MK, et al. Improving health outcomes of people with diabetes: target setting for the WHO global diabetes compact. Lancet 2023; 401: 1302–1312. - PMC - PubMed
    1. Centers for Disease Control and Prevention. Diabetes 2020 report card. 2017. Available at: https://www.cdc.gov/diabetes/pdfs/library/diabetesreportcard2020-508.pdf
    1. Nicolini F, Santarpino G, Gatti G, et al. Utility of glycated hemoglobin screening in patients undergoing elective coronary artery surgery: prospective, cohort study from the E-CABG registry. Int J Surg 2018; 53: 354–359. - PubMed
    1. Thourani VH, Weintraub WS, Stein B, et al. Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting. Ann Thorac Surg 1999; 67: 1045–1052. - PubMed

LinkOut - more resources