Perioperative control of BP, cholesterol and blood sugar improves CABG outcomes: study
According to a recent study published in the Journal of the American Heart Association, Perioperative control of BP, cholesterol, and blood sugar improves CABG outcomes.
Coronary artery bypass graft (CABG) surgery represents the preferred revascularization strategy for most diabetes and multivessel disease patients. We aimed to evaluate the role of optimized, perioperative cardiometabolic targets on long‐term survival in patients who underwent CABG.
Single‐institution retrospective study was conducted on patients with diabetes who underwent CABG between January 2010 and June 2018. Demographic, surgical, and cardiometabolic determinants were identified during the perioperative period. Clinical characteristics and longitudinal survival outcomes data were obtained. A total of 1534 patients with CABG were considered for analysis, and 1273 met inclusion criteria.
The results are:
The mean age of patients was 63.3 years (95% CI, 62.7–63.8 years), and most were men (65%) and Hispanic or Latino (47%). Comorbidities included hypertension (95%) and dyslipidemia (88%). In total, 490 patients (52%) had a low‐density lipoprotein cholesterol level >70 mg/dL. Furthermore, 390 patients (31%) had uncontrolled systolic blood pressure >130 mm Hg. Last, only 386 patients (29%) had a haemoglobin A1c level between 6% and 7%. At 5 years, 121 patients (10%) died. Failure to achieve goal systolic blood pressure was associated with all‐cause (hazard ratio [HR], 1.573; 95% CI, 1.048–2.362 [P=0.029]) and cardiovascular (HR, 2.023; 95% CI, 1.196–3.422 [P=0.009]) mortality at 5 years post‐CABG. In contrast, prescription of a statin during the perioperative interval demonstrated a protective effect for all‐cause (HR, 0.484; 95% CI, 0.286–0.819 [P=0.007]) and cardiovascular (HR, 0.459; 95% CI, 0.229–0.920 [P=0.028]) mortality. There was no association between the achievement of low‐density lipoprotein cholesterol, triglycerides, non–high‐density lipoprotein cholesterol, or haemoglobin A1c level goals and mortality risk at 5 years.
Thus, among patients with diabetes, blood pressure control and statin therapy were the most important perioperative cardiometabolic survival determinants 5 years after CABG.
Reference:
Perioperative Cardiometabolic Targets and Coronary Artery Bypass Surgery Mortality in Patients with Diabetes by John P. Skendelas et al. published in the Journal of the American Heart Association.
https://doi.org/10.1161/JAHA.121.023558
