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Preoperative hemoglobin A1c predicts atrial fibrillation after off-pump coronary bypass surgery.
MedLine Citation:
PMID:  21612941     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Diabetes mellitus has been recognized as a risk factor for mortality and morbidity after coronary bypass grafting, but a significant association between diabetes mellitus and postoperative atrial fibrillation (AF) has not been found. Although a recent study demonstrated a potential link between preoperative hemoglobin A1c level and risk of postoperative AF, there has not been sufficient examination of this relationship. We aimed to investigate the association between preoperative hemoglobin A1c and AF after isolated off-pump coronary bypass grafting.
METHODS: Of 912 consecutive patients undergoing isolated coronary bypass surgery, 805 were retrospectively analyzed for AF after excluding the following 107 cases: emergency (n=81), chronic AF (n=18), and pacemaker rhythm (n=8). We performed a group analysis with hemoglobin A1c levels categorized into tertiles of the baseline distribution and a continuous analysis based on 1% increments in hemoglobin A1c levels. The cutoff points for the tertiles were as follows: lower, 3.8-5.6% (n=283); middle, 5.7-6.7% (n=282); upper, 6.8-11.4% (n=240).
RESULTS: AF occurred in 159 patients (19.8%) after surgery. The median value (25th-75th percentile) of preoperative hemoglobin A1c was significantly lower in patients who developed AF than in those who did not (5.8 (5.4-6.3) vs 6.1 (5.5-7.2), p=0.01). The incidence of postoperative AF was 28.3% (80/283) in the lower tertile, 17.4% (49/282) in the middle tertile, and 12.5% (30/240) in the upper tertile (p for trend=0.01). The unadjusted odds ratio (95% confidence interval) for the association between hemoglobin A1c and postoperative AF was 0.70 (0.61-0.83) per 1% increase and 0.42 (0.29-0.70) for the upper versus the lower tertile. This association persisted after adjustment for the univariate predictors (0.74 (0.60-0.92) per 1% increase; 0.54 (0.31-0.90) for upper vs lower tertile) and the known risk factors (0.78 (0.63-0.95) per 1% increase; 0.55 (0.35-0.88) for upper vs lower tertile). The area under the receiver operator characteristic curve (95% confidence interval) for preoperative hemoglobin A1c as a predictor of postoperative AF was 0.70 (0.65-0.75) (p=0.01).
CONCLUSIONS: Preoperative hemoglobin A1c independently predicts the occurrence of AF after isolated off-pump coronary bypass grafting.
Takeshi Kinoshita; Tohru Asai; Tomoaki Suzuki; Atsushi Kambara; Keiji Matsubayashi
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  41     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-03-01     Completed Date:  2012-05-01     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  102-7     Citation Subset:  IM    
Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan.
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MeSH Terms
Aged, 80 and over
Atrial Fibrillation / blood,  diagnosis,  etiology*
Biological Markers / blood
Coronary Artery Bypass, Off-Pump / adverse effects*
Diabetes Complications / blood,  diagnosis
Diabetes Mellitus / blood
Hemoglobin A, Glycosylated / analysis*
Middle Aged
Preoperative Period
Retrospective Studies
Risk Factors
Reg. No./Substance:
0/Biological Markers; 0/Hemoglobin A, Glycosylated; 0/hemoglobin A1c protein, human

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