October 10, 2014
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Strict glycemic control did not affect survival after CABG

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There was no difference in survival after CABG between patients who underwent a strict glycemic control strategy compared with those who underwent a liberal strategy, according to recent study data.

Researchers assessed long-term survival in patients (mean age, 62.7 years; 16% women) randomly assigned to a strict glucose-control strategy (90-120 mg/dL; n=91) or to a liberal one (121-180 mg/dL; n=98) before undergoing isolated CABG for the first time. Previous research had established that glycemic control during the perioperative period improves morbidity and mortality in patients undergoing CABG, but those results were conflicting with regard to the long-term effect of glucose-control approaches, according to the study background.

Besides survival, A. Thomas Pezzella, MD, and colleagues assessed health-related quality of life based on the Short Form-12 (SF-12). Mean follow-up was 40 months.

In an intention-to-treat analysis, Pezzella, from Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, Va., and colleagues found no difference between the groups in cumulative survival during the study period (strict group, 95.5%; liberal group, 93.5%; log rank=0.32; P=.57). A completer analysis and a per-protocol analysis yielded similar results.

According to an intention-to-treat analysis of the 41 patients with evaluable SF-12 data at baseline and at 6 months, physical health-related quality of life improved significantly in all patients (P<.001), with no significant differences between the groups (P=.7). Results from a completer analysis were similar.

The Society of Thoracic Surgeons recommends target maintenance glucose levels <180 mg/dL for at least 24 hours after CABG, the researchers wrote. “Our experience, as well as that of others, supports this approach, given the potential negative consequences of hypoglycemia associated with tight control,” they wrote. “… In our original manuscript, we reported that the strict glucose control protocol took longer for patients to reach target range, had greater readings outside the target range and a greater number of patients with hypoglycemic events.”

In an invited commentary, Harold L. Lazar, MD, of the department of cardiothoracic surgery at Boston Medical Center, wrote that his institution had performed a similar study and found “no difference in the incidence of 30-day mortality, [MI], neurologic events, deep sternal wound infection or atrial fibrillation between the groups.”

He noted that the study by Pezzella and colleagues did not report differences between the groups in the incidence of cardiac-related issues, whereas the study by his institution will report cardiac events at 5 years. “Although more aggressive control may not prolong survival, these data will help us determine whether more aggressive perioperative glycemic control will translate into superior long-term freedom from cardiac-related events,” he wrote.

For more information:

Lazar HL. Ann Thorac Surg. 2014;98:1285.

Pezzella AT. Ann Thorac Surg. 2014;98:1281-1285.