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Dynamics of perioperative glycemia after off-pump and on-pump coronary artery bypass grafting in patients with type 2 diabetes mellitus

Authors: Kudryashova E.N., Berdibekov B.Sh., Bulaeva N.I., MerzlyakovV.Yu., Batov S.M., Salomov M.A., Dzhidzalova D.Kh., Khoroshikh L.V., Tarasova K.A., Golukhova E.Z.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2023-17-4-491-501

For citation: Kudryashova E.N., Berdibekov B.Sh., Bulaeva N.I., Merzlyakov V.Yu., Batov S.M., Salomov M.A., Dzhidzalova D.Kh., Khoroshikh L.V., Tarasova K.A., Golukhova E.Z. Dynamics of perioperative glycemia after off-pump and on-pump coronary artery bypass grafting in patients with type 2 diabetes mellitus. Creative Cardiology. 2023; 17 (4): 491–501 (in Russ.). DOI: 10.24022/1997-3187-2023-17-4-491-501

Received / Accepted:  04.11.2023 / 24.11.2023

Keywords: on-pump coronary artery bypass grafting hyperglycemia diabetes mellitus



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Abstract

Objective. To provide an analysis of glycose level dynamics and factors that influence hyperglycemia in the early postoperative period in patients with type 2 diabetes mellitus (DM) who underwent off-pump coronary artery bypass (OPCAB) and on-pump coronary artery bypass (ONCAB).

Material and methods. A retrospective study included 40 patients who underwent ONCAB and 40 patients who underwent OPCAB. The average age of the patients was 61.4±6.8 years, 59 (73.8%) patients were male. Plasma glucose of more than 10 mmol/L for 24 h after cardiac surgery was taken as an indicator of poor glycemic control.

Results. Analyzing the dynamics of glycemia after coronary artery bypass grafting (CABG) (ONCAB and OPCAB) at different stages of the perioperative period, statistically significant patterns were not found between the initial glucose levels before CABG surgery (7.1 [6.0–8.5] and 7.4 [6.8–8.2] mmol/l, respectively, p=0.436). However, on the first and second days after surgery, statistically significant higher glucose levels were observed in the group undergoing ONCAB compared to OPCAB group (11.0 [9.1–13.3] versus 8.6 [7.8–11.6] mmol/l, p=0.005 and 9.0 [7.3–10.7] versus 7.5 [6.9–8.7] mmol/l, p=0.025, respectively). Also, on the 3rd day after surgery and before discharge, the blood glucose level between the groups of ONCAB and OPCAB did not differ statistically significantly (7.3 [6.2–8.9] versus 6.8 [6.4–7.7] mmol/l, p=0.711 and 6.7 [6.5–8.4] versus 6.8 [6.2–7.8] mmol/l, p=0.760, respectively). Using multivariate binary logistic analysis was found that male gender (odds ratio (OR) 4.00; 95% confidence interval (CI) 1.23–13.04; p=0.021) and ONCAB as the method of revascularization (OR 3.02; 95% CI 1.15–7.91; p=0.024) were predictors of the poor glucose control within first day after surgery.

Conclusion. According to the results of the present study, OPCAB is associated with better postoperative glucose control compared with glucose maintenance in patients undergoing ONCAB.

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About Authors

  • Elena N. Kudryashova, Cardiologist; ORCID
  • Bektur Sh. Berdibekov, Cardiologist; ORCID
  • Naida I. Bulaeva, Cand. Biol. Sci., Associate Professor, Head of Department, Cardiologist; ORCID
  • Vadim Yu. Merzlyakov, Dr. Med. Sci., Professor, Cardiovascular Surgeon, Head of Department; ORCID
  • Sergey M. Batov, Cardiovascular Surgeon; ORCID
  • Machmadsharif A. Salomov, Researcher, Cardiovascular Surgeon; ORCID
  • Diana Kh. Dzhidzalova, Cardiologist; ORCID
  • Ludmila V. Khoroshikh, Cardiologist; ORCID
  • Ksenia A. Tarasova, Postgraduate; ORCID
  • Elena Z. Golukhova, Dr. Med. Sci., Professor, Academician of RAS, Director; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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