Are even impaired fasting blood glucose levels preoperatively associated with increased mortality after CABG surgery?

doi:10.1093/eurheartj/ehi182

European Heart Journal Advance Access originally published online on March 30, 2005
European Heart Journal 2005 26(15):1513-1518; doi:10.1093/eurheartj/ehi182

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Are even impaired fasting blood glucose levels preoperatively associated with increased mortality after CABG surgery?

R.E. Anderson¹^,*, K. Klerdal², T. Ivert¹, N. Hammar³^,4, G. Barr¹ and A. Öwall¹

¹Department of Cardiothoracic Surgery and Anaesthesiology, Karolinska University Hospital, S-171 76 Stockholm, Sweden
²Department of Epidemiology, Stockholm Centre for Public Health, Stockholm, Sweden
³Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
⁴AstraZeneca Research & Development, Mölndal, Sweden

Received 30 June 2004; revised 12 December 2004; accepted 27 January 2005; online publish-ahead-of-print 30 March 2005.

^* Corresponding author. Tel: +46 8 51774146; fax: +46 8 322701.E-mail address: russell.anderson{at}kirurgi.ki.se

Aims Impaired fasting glucose (IFG) below the diagnostic thresholdfor diabetes mellitus (DM) is associated with macrovascularpathology and increased mortality after percutaneous coronaryinterventions. The study goal was to determine whether pre-operativefasting blood glucose (fB-glu) is associated with an increasedmortality after coronary artery bypass grafting (CABG).

Methods and results During 2001–03, 1895 patients underwentprimary CABG [clinical DM (CDM) in 440/1895; complete data onfB-glu for n=1375/1455]. Using pre-operative fB-glu, non-diabeticswere categorized as having normal fB-glu (<5.6 mmol/L),IFG (5.6 $≤$ fB-glu<6.1 mmol/L), or suspected DM (SDM) ( $≥$ 6.1 mmol/L).fB-glu was normal in 59%. The relative risks of 30 day and 1year mortality compared with patients with normal fB-glu was1.7 [95% confidence interval (CI): 0.5–5.5] and 2.9 (CI:0.8–11.2) with IFG, 2.8 (CI: 1.1–7.2) and 1.9 (CI:0.5–6.3) with SDM vs. 1.8 (CI: 0.8–4.0) and 1.6(CI: 0.6–4.3) if CDM, respectively. The receiver operatorcharacteristic area for the continuous variable fB-glu and 1year mortality was 0.65 (P=0.002).

Conclusion The elevated risk of death after CABG surgery knownpreviously to be associated with CDM seems also to be sharedby a group of similar size that includes patients with IFG andundiagnosed DM.

Key Words: Blood glucose • Diabetes mellitus • Mortality • Coronary artery bypass grafting

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