The relationship between HbA1c & atrial fibrillation after off-pump coronary artery bypass surgery in diabetic patients

[Atrial Fibrillation After Coronary Artery Bypass Surgery: Risk Factors, Prevention and Treatment]

This review focuses on the issue of atrial fibrillation (AF) following coronary bypass surgery in patients with ischemic heart disease. Risk factors of this complication are discussed in detail. The authors addressed the effect of diabetes mellitus on development of postoperative AF. Data on current methods for prevention and treatment of AF are provided.

Dose-response analysis between hemoglobin A1c and risk of atrial fibrillation in patients with and without known diabetes

Background

The relationship between serum hemoglobin A1c (HbA1c) and atrial fibrillation (AF) or postoperative AF (POAF) in coronary artery bypass (CABG) patients is still under debate. It is also unclear whether there is a dose-response relationship between circulating HbA1c and the risk of AF or POAF.

Methods and results

The Cochrane Library, PubMed, and EMBASE databases were searched. A robust-error meta-regression method was used to summarize the shape of the dose-response relationship. The RR and 95%CI were using a random-effects model. In total, 14 studies were included, totaling 17,914 AF cases among 352,325 participants. The summary RR per 1% increase in HbA1c was 1.16 (95% CI: 1.07–1.27). In the subgroup analysis, the summary RR was 1.13 (95% CI: 1.08–1.19) or 1.12 (95% CI: 1.05–1.20) for patients with diabetes or without known diabetes, respectively. The nonlinear analysis showed a nonlinear (P_nonlinear = 0.04) relationship between HbA1c and AF, with a significantly increased risk of AF if HbA1c was over 6.3%. However, HbA1c (per 1% increase) was not associated with POAF in patients with diabetes (RR: 1.13, P = 0.34) or without known diabetes (RR: 0.91, P = 0.37) among patients undergoing CABG.

Conclusion

Our results suggest that higher HbA1c was associated with an increased risk of AF, both in diabetes and in without diabetes or with unknown diabetes. However, no association was found between HbA1c and POAF in patients undergoing CABG. Further prospective studies with larger population sizes are needed to explore the association between serum HbA1c level and the risk of POAF.

Myocardial revascularization in patients with coronary heart disease and type 2 diabetes

The review discusses myocardial revascularization in patients with coronary heart disease and type 2 diabetes. The data presented include findings from recent research and international and national recommendations and provides evidence on the advantages of coronary artery bypass surgery over percutaneous coronary intervention for patients with diabetes mellitus, stable coronary artery disease and multiple coronary artery lesions. Type 2 diabetes remains a significant predictor of adverse long-term outcomes of coronary artery bypass surgery. Therefore, we review studies showing that different strategies of coronary revascularization and preoperative preparation can affect the results of coronary intervention in patients with diabetes.