Abstract 2314: Insulin is the Protective Component of Glucose-Insulin-Potassium Solutions during Coronary Artery Bypass Graft Surgery in Patients with Diabetes

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Harold L Lazar ◽  
Marie McDonnell ◽  
Stuart Chipkin ◽  
Yusheng Bao ◽  
Carmel Fitzgerald ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Heart Association ◽  
Diabetic Patients ◽  
Protective Effects ◽  
Term Survival ◽  
Perioperative Morbidity ◽  
Patients With Diabetes ◽  
Cabg Patients

Maintaining glycemic control(120 –180mg/dl)with GIK solutions in patients with diabetes undergoing CABG decreases perioperative morbidity and enhances long-term survival. The mechanism by which GIK exerts its protective effects is unknown. This study was undertaken to determine whether it is substrate enhancement with glucose, glycemic control with insulin, or the combination of glucose + insulin + potassium which contributes to improved outcomes with GIK in CABG patients with diabetes. One hundred-twenty diabetic patients undergoing isolated CABG surgery were prospectively randomized to achieve glycemic control(120 –180mg/dl)using an INSULIN infusion(100units/100mlNS),LOW GIK(500mlD5W + 80units insulin + 40mEqKCL), and HIGH GIK(D20W + 200units insulin + 80mEqKCL) beginning on anesthetic induction and continuing for 18 hours after surgery. Variables assessed included Major Adverse Events(MAE=death, MI, CVA, atrial fibrillation, infection, ventilation > 24 hours, inotropic usage > 24hours,lenght of stay > 7days), serum glucose, the amount of insulin infused, and serum free fatty acids(ffa).Values are mean+/− standard deviation. HIGH GIK delivered more insulin and resulted in significantly lower levels of glucose and ffa. However, it had no effect on the incidence of MAEs compared to INSULIN infusions without glucose and potassium. Insulin, rather than substrate enhancement with glucose and potassium, is the key element in GIK used in CABG patients with diabetes. Augmenting insulin delivery results in lower levels of glucose and ffa, but has no effect on clinical outcomes as long as gylcemic control(120 –180mg/dl) is achieved. This research has received full or partial funding support from the American Heart Association, AHA National Center. RESULTS

scholarly journals Intensity of Glycemic Control Affects Long-Term Survival After Coronary Artery Bypass Graft Surgery

2019 ◽  
Vol 107 (2) ◽  
pp. 477-484 ◽  
Author(s):  
Michael P. Robich ◽  
Alexander Iribarne ◽  
Bruce J. Leavitt ◽  
David J. Malenka ◽  
Reed D. Quinn ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Glycemic Control ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Term Survival ◽  
Long Term Survival

scholarly journals Frequency of deep infection of the sternal wound in diabetic patients utilizing skeletonized versus pedicled harvesting technique of internal thoracic artery after CABG surgery.

2019 ◽  
Vol 26 (11) ◽  
pp. 1866-1872
Author(s):  
Riffat Tanveer ◽  
Asad Khan ◽  
Muhammad Musharaf ◽  
Amina Nasreen
Keyword(s):  
Internal Thoracic Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Deep Infection ◽  
Diabetic Patients ◽  
Chi Square ◽  
Cabg Surgery ◽  
Harvesting Technique ◽  
Patients With Diabetes ◽  
Chi Square Test

Objectives: After coronary artery bypass graft (CABG) surgery, infection of the sternum is a serious issue as it would adversely affect the mortality of patient. Left internal thoracic artery (LITA) has significant benefits but after its utilization occurrence of sternal infection is documented especially in diabetic patients due to impairment in blood flow of sternum. Our objective was to document the frequency of deep infection of the sternal wound in patients with diabetes utilizing skeletonized versus pedicled harvesting technique of the left ITA after CABG Surgery in our population. Study Design: An observational study was retrospectively done. Setting: National Institute of Cardiovascular Diseases, Karachi. Period: January 2013 to October 2015. Material and Methods: The sample size of the study was determined to be a total of two hundred and twenty patients who had primary, isolated and elective CABG surgery. One hundred and ten patients were included in whom skeletonized left ITA was utilized and in one hundred and ten patients pedicled left ITA was utilized. We used the statistical Chi square test and p < 0.05 was considered significant. Results: Deep infection of the sternal wound occurred in 3.64% of the patients with diabetes in whom the pedicled left ITA was utilized and did not occur in any of the diabetic patients in whom the skeletonized left ITA was utilized. Post CABG surgery frequency of deep infection of the sternal wound was greater in those patients in whom the LITA was harvested utilizing the pedicled technique (p<0.05). Conclusion: There is decreased frequency of deep infection of the sternal wound in patients with diabetes utilizing the skeletonized harvesting technique of the left ITA after CABG Surgery.

Quantification of Coronary Artery Stenosis with 16-Slice MSCT in Patients before CABG Surgery: Comparison to Standard Invasive Coronary Angiography

2005 ◽  
Vol 8 (1) ◽  
pp. 42 ◽  
Author(s):  
C. Probst ◽  
A. Kovacs ◽  
C. Schmitz ◽  
W. Schiller ◽  
H. Schild ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Artery Bypass ◽  
Invasive Coronary Angiography ◽  
Bypass Graft ◽  
Heart Association ◽  
Artery Stenosis ◽  
Vessel Disease ◽  
Selective Coronary Angiography

Objective: Invasive, selective coronary angiography is the gold standard for evaluation of coronary artery disease (CAD) and degree of stenosis. The purpose of this study was to compare 3-dimensional (3D) reconstructed 16-slice multislice computed tomographic (MSCT) angiography and selective coronary angiography in patients before elective coronary artery bypass graft (CABG) procedure. Methods: Sixteen-slice MSCT scans (Philips Mx8000 IDT) were performed in 50 patients (42 male/8 female; mean age, 64.44 8.66 years) scheduled for elective CABG procedure. Scans were retrospectively electrocardiogram-gated 3D reconstructed. The images of the coronary arteries were evaluated for stenosis by 2 independent radiologists. The results were compared with the coronary angiography findings using the American Heart Association segmental classification for coronary arteries. Results: Four patients (8%) were excluded for technical reasons. Thirty-eight patients (82.6%) had 3-vessel disease, 4 (8.7 %) had 2-vessel disease, and 4 (8.7%) had an isolated left anterior descending artery stenosis. In the proximal segments all stenoses >50% (56/56) were detected by MSCT; medial segment sensitivity was 97% (73/75), specificity 90.3%; distal segment sensitivity was 90.7% (59/65), specificity 77%. Conclusion: Accurate quantification of coronary stenosis greater than 50% in the proximal and medial segments is possible with high sensitivity and specificity using the new generation of 16-slice MSCTs. There is still a tendency to overestimate stenosis in the distal segments. MSCT seems to be an excellent diagnostic tool for screening patients with possible CAD.

Management of the Asymptomatic Diabetic Patient with Evidence of Ischaemia

2010 ◽  
Vol 6 (1) ◽  
pp. 62
Author(s):  
Dimitrios Bliagos ◽  
Ajay J Kirtane ◽  
Jeffrey W Moses ◽  
◽  
◽  
...  
Keyword(s):  
Coronary Artery ◽  
Medical Therapy ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Ageing Population ◽  
Patients With Diabetes ◽  
Risk Patients ◽  
Asymptomatic Diabetic Patient ◽  
Artery Disease

In the US, a total of 23.6 million people have diabetes, representing 7.8% of the population, and the prevalence of diabetes is on the rise due to an increasingly sedentary lifestyle, increasing obesity and an ageing population. Coronary artery disease is the leading cause of death in patients with diabetes, despite a reduction in cardiovascular events over the last 50 years, due in part to better medical therapy. Asymptomatic diabetic patients with evidence of ischaemia on stress testing have higher cardiac mortality; increasing amounts of ischaemia are associated with higher mortality rates. Revascularisation of high-risk patients, or those with significant ischaemia, has the potential to improve outcomes in this patient population. The choice of which revascularisation strategy to choose – either percutaneous coronary intervention (PCI) or coronary artery bypass grafting – should be carefully individualised, and must always be implemented against the background of optimal medical therapy.

scholarly journals A preliminary study on diabetes self-management education and glycemic control among patients with diabetes mellitus

2019 ◽  
Vol 9 (9) ◽  
pp. 98 ◽  
Author(s):  
Kisokanth G. ◽  
Indrakumar J. ◽  
Prathapan S. ◽  
Joseph J. ◽  
Ilankoon I.M.P.S.
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Management Education ◽  
Self Management ◽  
Rank Test ◽  
Diabetic Patients ◽  
Effective Measure ◽  
Before And After ◽  
Patients With Diabetes ◽  
Preliminary Study

This study was aimed to assess the effectiveness of diabetes self-management education (DSME) in the improvement of glycemic control among patients with type 2 Diabetes Mellitus (T2DM) in Batticaloa District, Sri Lanka. The study was a prospective interventional study and conducted as a preliminary study at medical clinic, Base hospital, Kaluwanchikudy, Batticaloa. Thirty patients with T2DM were included based on inclusion and exclusion criteria. A structured individual diabetes self-management education for 10 hours (one hour per week) was delivered to diabetic patients by the trained Nurse Health Educator. Glycosylate hemoglobin (HbA1c) was assessed as a main outcome measure and Fasting Blood Sugar (FBS), Body Mass Index (BMI) of each patient were also measured and recorded before and after the intervention. The respondent rate was 96.7% (n = 29). Majority of them were females (n = 25, 86.2%). A Wilcoxon signed rank test showed that DSME had a statistically significant reduction in HbA1c [8.60 (IQR 2.60) vs. 7.40 (IQR 2.10), p = .000] and FBS level [159.00 (IQR 77.50) vs. 134.00 (IQR 40.50), p = .002] at 3 months of intervention. The mean BMI at baseline was higher compared to 3 months of intervention [24.88 (SD ± 3.06) vs. 24.19 (SD ± 2.79)] which was statistically significant (p = .000). Majority of participants (n = 22, 75.9%) had improved their HbA1c level by ≥ 0.5% in 3 months. The diabetes self-management education is an effective measure in improving glycemic control and other clinical parameters among patients with T2DM. Thus, DSME needs to be implemented among clinic patients with T2DM for the better outcome and the preventions of complications.

Factors associated with return to work after coronary artery bypass grafting (CABG)

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Raynaldo
Keyword(s):  
Diabetes Mellitus ◽  
Logistic Regression ◽  
Coronary Artery ◽  
Return To Work ◽  
Coronary Artery Bypass ◽  
Functional Capacity ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Factors Associated ◽  
Cabg Patients

Abstract Funding Acknowledgements Type of funding sources: None. Background. Postoperative CABG patients will generally experience improvement in symptoms and functional capacity. Post-CABG patients are expected to be productive again in order to have a positive impact on both patient and the society socio-economically, in addition to other parameters such as morbidity, mortality and serious adverse events. Purpose to determine the factors that associated with return to work in CABG patients in one General Hospital. Methods. We analyzed data from Adam Malik Hospital registry of 68 patients who had undergone CR after coronary artery bypass graft (CABG) in 2017-2020. The outcomes assessed were work status in 6 month after CABG. Patients’ characteristics, sociodemographic, clinical parameters of functional capacity using 6 minutes of walk test (6MWT), T2DM, Hypertension and cholesterol level were assessed. Factors associated with return to work were identified using multivariable logistic regression. Results We identified 68 patients undergoing isolated CABG (2017–2020). One year after discharge for CABG, 40 (58.8%) patients had returned to the workforce. Factors associated with return to work  were identified using bivariate logistic regression. Diabetes mellitus (odds ratio, 10.192; 95% confidence interval, 0.063–0.515). Conclusion Almost 2 from 3 patients after CABG returned to work within 6 months. Diabetes mellitus and functional capacity were associated with a lower likelihood of returning to work.

scholarly journals Prognostic utility of early systolic lengthening by speckle tracking in patients undergoing coronary artery bypass graft

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
P Brainin ◽  
S Lindberg ◽  
F Olsen ◽  
S Pedersen ◽  
A Iversen ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Speckle Tracking ◽  
Prognostic Value ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Positive Strain ◽  
All Cause Mortality ◽  
Cabg Patients

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Independent Research Fund Denmark Background Early systolic lengthening (ESL), a paradoxical stretch of myocardial fibers, has been linked to myocardial viability and contractile dysfunction. We assessed the long-term prognostic potential of ESL in coronary artery bypass graft (CABG) patients. Methods We retrospectively included patients (n = 709; mean age 68 years; 85% men) who underwent speckle tracking echocardiography (median 15 days) prior to CABG. Endpoints were cardiovascular death (CVD) and all-cause mortality. We assessed amplitude of ESL (%), defined as peak positive strain, and duration of ESL (ms), determined as time from Q-wave on the ECG to peak positive strain. We applied Cox proportional hazards models adjusted for the clinical risk tool, EuroSCORE II. Results During median follow-up of 3.8 years [IQR 2.7 to 4.9 years], 45 (6%) experienced CVD and 80 (11%) died. In survival analyses adjusted for EuroSCORE II, amplitude of ESL was associated with CVD (HR 1.37 [95%CI 1.13 to 1.66], P = 0.001) and all-cause mortality (HR 1.31 [95%CI 1.13 to 1.54], P = 0.001). Similar findings applied to duration of ESL and CVD (HR 1.17 [95%CI 1.08 to 1.26], P &lt; 0.001) and all-cause mortality (HR 1.14 [95%CI 1.07 to 1.21], P &lt; 0.001). The prognostic value of ESL amplitude was modified by sex (P interaction &lt; 0.05), such that it was greater in women for both endpoints (Figure 1A-B). When adding ESL duration to EuroSCORE II, the net reclassification index improved significantly for both CVD and all-cause mortality. Conclusions Assessment of ESL provides independent and incremental prognostic information in addition to the EuroSCORE II for CVD and all-cause mortality in CABG patients. The prognostic value was greater in women. Abstract Figure. Prognostic value of ESL amplitude by sex

Sign in / Sign up

Export Citation Format

Share Document