TY - JOUR
T1 - Superiority of moderate control of hyperglycemia to tight control in patients undergoing coronary artery bypass grafting
AU - Bhamidipati, Castigliano M.
AU - Lapar, Damien J.
AU - Stukenborg, George J.
AU - Morrison, Christine C.
AU - Kern, John A.
AU - Kron, Irving L.
AU - Ailawadi, Gorav
N1 - Funding Information:
Supported by T32/HL007849 (to C.M.B., D.J.L.) from the National Heart, Lung, and Blood Institute . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the National Institutes of Health. Also supported by Thoracic Surgery Foundation for Research and Education Research Grant (to G.A.).
PY - 2011/2
Y1 - 2011/2
N2 - Objective: Although consensus in cardiac surgery supports tight control of perioperative hyperglycemia (glucose <120 mg/dL), recent studies in critical care suggest moderate glycemic control may be superior. We sought to determine whether tight control or moderate glycemic control is optimal after coronary artery bypass grafting. Methods: From 1995 to 2008, a total of 4658 patients with known diabetes or perioperative hyperglycemia (preoperative glycosylated hemoglobin ≥8 or postoperative serum glucose >126 mg/dL) underwent isolated coronary artery bypass grafting at our institution. Patients were stratified into 3 postoperative glycemic groups: tight (≤126 mg/dL), moderate (127-179 mg/dL), and liberal (≥180 mg/dL). Preoperative risk factors, glycemic management, and postoperative outcomes were analyzed. Results: Operative mortality was 2.5% (119/4658); major complication rate was 12.5% (581/4658). Relative to moderate group, more patients in tight group had preoperative renal failure (tight 16.4%, 22/134, moderate 8.3%, 232/2785, P = .001) and underwent emergent operations (tight 5.2%, 7/134, moderate 1.9%, 52/2785, P = .007); however, Society of Thoracic Surgeons predicted mortality risk was lower in tight group (P < .001). Moderate group had lowest mortality (tight 2.9%, 4/134, moderate 2.0%, 56/2785, liberal 3.4%, 59/1739, P = .02) and incidence of major complications (tight 19.4%, 26/134, moderate 11.1%, 308/2785, liberate 14.2%, 247/1739, P < .001). Risk-adjusted major complication incidence (adjusted odds ratio 0.7, 95% confidence interval 0.58-0.87) and mortality (adjusted odds ratio 0.6, 95% confidence interval 0.37-0.83) were lower with moderate glucose control than with tight or liberal management. Conclusions: Moderate glycemic control was superior to tight glycemic control, with decreased mortality and major complications, and may be ideal for patients undergoing isolated coronary artery bypass grafting.
AB - Objective: Although consensus in cardiac surgery supports tight control of perioperative hyperglycemia (glucose <120 mg/dL), recent studies in critical care suggest moderate glycemic control may be superior. We sought to determine whether tight control or moderate glycemic control is optimal after coronary artery bypass grafting. Methods: From 1995 to 2008, a total of 4658 patients with known diabetes or perioperative hyperglycemia (preoperative glycosylated hemoglobin ≥8 or postoperative serum glucose >126 mg/dL) underwent isolated coronary artery bypass grafting at our institution. Patients were stratified into 3 postoperative glycemic groups: tight (≤126 mg/dL), moderate (127-179 mg/dL), and liberal (≥180 mg/dL). Preoperative risk factors, glycemic management, and postoperative outcomes were analyzed. Results: Operative mortality was 2.5% (119/4658); major complication rate was 12.5% (581/4658). Relative to moderate group, more patients in tight group had preoperative renal failure (tight 16.4%, 22/134, moderate 8.3%, 232/2785, P = .001) and underwent emergent operations (tight 5.2%, 7/134, moderate 1.9%, 52/2785, P = .007); however, Society of Thoracic Surgeons predicted mortality risk was lower in tight group (P < .001). Moderate group had lowest mortality (tight 2.9%, 4/134, moderate 2.0%, 56/2785, liberal 3.4%, 59/1739, P = .02) and incidence of major complications (tight 19.4%, 26/134, moderate 11.1%, 308/2785, liberate 14.2%, 247/1739, P < .001). Risk-adjusted major complication incidence (adjusted odds ratio 0.7, 95% confidence interval 0.58-0.87) and mortality (adjusted odds ratio 0.6, 95% confidence interval 0.37-0.83) were lower with moderate glucose control than with tight or liberal management. Conclusions: Moderate glycemic control was superior to tight glycemic control, with decreased mortality and major complications, and may be ideal for patients undergoing isolated coronary artery bypass grafting.
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U2 - 10.1016/j.jtcvs.2010.10.005
DO - 10.1016/j.jtcvs.2010.10.005
M3 - Article
C2 - 21163498
AN - SCOPUS:78751580552
SN - 0022-5223
VL - 141
SP - 543
EP - 551
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 2
ER -