Elevated preoperative HBA1C: Could off-pump CABG improve the surgical outcome?

Abstract

Background: Dysglycemia is a well-established risk factor for coronary artery disease (CAD). Numerous studies have found a substantial link between uncontrolled diabetic mellitus (DM) and adverse outcomes following Coronary artery bypass grafting (CABG).
Aim of study: We aimed to disclose if off-pump CABG (OP-CAB) has a better outcome than on-pump CABG (ON-CAB) in patients with elevated glycated hemoglobin (HBA1C).
Methods: Perioperative Data regarding 945 diabetic patients with elevated HBA1C (> 6 mmol/L) who underwent CABG between January 2020 and July 2024 in Kasr-alainy, Fayoum, Beniseuf university hospitals and Naser national institute were gathered and patients were divided into two groups; Group A or the ON-CAB group that included 477 patients and Group B or the OP-CAB group that included 468 patients.
Results: Compared to ON-CAB group, OP-CAB group showed statistically significant (P value < 0.05) shorter post-operative intensive care unit (ICU) stay (3.02± 0.60 vs. 6.13± 1.65), Hospital stays (5.8 ± 3.4 vs. 6.7 ± 4.5), less need for Intra-Aortic Ballon Pump; IABP (76 vs 110), High vasopressor therapy (69 vs 98), lower incidence of Re-sternotomy (12 vs. 25), Mediastinitis (6 vs.16), new Renal Dialysis (3 vs. 11) and Early Mortality (7 vs.17). Although there were differences between both groups in terms of less postoperative myocardial infarction (MI) and unstable angina (UA) in Group A, as well as a lower incidence of post-operative stroke, blood transfusion, and renal failure (needing no dialysis) in Group B, the differences were not statistically significant (P value > 0.05).
Conclusion: Whenever possible, we recommend the OP-CAB technique in diabetic patients with elevated HBA1C who are candidates for CABG.