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Can HbA1c Predict Major Adverse Events and Mortality in Coronary Artery Bypass Grafting? – A Systematic Review and Meta Analysis

Author : A. Z. Barano, M. Abduh , E. N. Putri, M. F. Addai
Upload Date : 19-04-2018

Background: Inadequate glycemic control presented by high hemoglobin A1c (HbA1c) level can contribute to major adverse events (MAEs) and mortality after coronary artery bypass grafting (CABG). We aimed to analyze the predictive role of HbA1c for MAEs and mortality in CABG.

Methods: PubMed database was searched for studies evaluating the relationship between HbA1c, MAEs, and mortality after CABG in diabetes patients with coronary artery disease (CAD). Fixed-effects model was used and the results were presented in odds ratio (OR), confidence intervals (CI), significance (p), and heterogeneity (I2).

Results: A total of 11 studies (10,587 samples) were enrolled and 45.3% (4,796) of samples were having a high HbA1c level. Numbers of mortality was 3.94% (n= 189, OR= 1.73, 95% CI 1.39-2.15, p < 0.05, I2 = 68%). Numbers of MAEs: myocardial infarct was 1.10% (n= 22, OR= 1.59, 95% CI 0.86-2.93, p = NS, I2 = 53%), pneumonia was 15.90% (n= 549, OR= 1.18, 95% CI 1.03-1.35, p < 0.05, I2 = 0%), postoperative atrial fibrillation (POAF) was 13.40% (n= 562, OR= 0.73, 95% CI 0.65-0.82, p < 0.05, I2 = 87%), renal failure was 4.60% (n= 207, OR= 1.83, 95% CI 1.46-2.30, p < 0.05, I2 = 44%), sepsis was 3.23% (n= 12, OR= 6.97, 95% CI 2.10-23.12, p < 0.05, I2 = 0%), stroke was 2.81% (n= 124, OR= 1.75, 95% CI 1.31-2.34, p < 0.05, I2 = 0%), surgical site infection was 3.85% (n= 93, OR= 2.55, 95% CI 1.80-3.62, p < 0.05, I2 = 41%), and cardiac tamponade was 1.37% (n= 11, OR= 1.05, 95% CI 0.48-2.31, p = NS, I2 = 0%).

Conclusion: High HbA1c level can predict the incidence of MAEs and mortality in diabetes patients with CAD who underwent CABG.

KEYWORDS : HbA1c, Adverse Events, Coronary Artery Bypass Grafting, Cardiac Surgery.

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