Circulation. 2004;109:1497-1502
Published online before print March 8, 2004, doi: 10.1161/01.CIR.0000121747.71054.79
Published online before print March 8, 2004, doi: 10.1161/01.CIR.0000121747.71054.79
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(Circulation. 2004;109:1497-1502.)
© 2004 American Heart Association, Inc.
Clinical Investigation and Reports |
Tight Glycemic Control in Diabetic Coronary Artery Bypass Graft Patients Improves Perioperative Outcomes and Decreases Recurrent Ischemic Events
From the Departments of Cardiothoracic Surgery (H.L.L., C.A.F., Y.B.), Biostatistics (H.C.), and Cardiology (C.S.A.), Boston University School of Medicine and Boston Medical Center, Boston, and the Division of Endocrinology (S.R.C.), Baystate Medical Center, Springfield, Mass.
Correspondence to Harold L. Lazar, MD, Department of Cardiothoracic Surgery, Boston Medical Center, 88 E Newton St, B402, Boston, MA 02118. E-mail harold.lazar{at}bmc.org
Received October 24, 2003; revision received December 29, 2003; accepted January 8, 2004.
Background— This study sought to determine whether tight glycemic control with a modified glucose-insulin-potassium (GIK) solution in diabetic coronary artery bypass graft (CABG) patients would improve perioperative outcomes.
Methods and Results— One hundred forty-one diabetic patients undergoing CABG were prospectively randomized to tight glycemic control (serum glucose, 125 to 200 mg/dL) with GIK or standard therapy (serum glucose <250 mg/dL) using intermittent subcutaneous insulin beginning before anesthesia and continuing for 12 hours after surgery. GIK patients had lower serum glucose levels (138±4 versus 260±6 mg/dL; P<0.0001), a lower incidence of atrial fibrillation (16.6% versus 42%; P=0.0017), and a shorter postoperative length of stay (6.5±0.1 versus 9.2±0.3 days; P=0.003). GIK patients also showed a survival advantage over the initial 2 years after surgery (P=0.04) and decreased episodes of recurrent ischemia (5% versus 19%; P=0.01) and developed fewer recurrent wound infections (1% versus 10%, P=0.03).
Conclusions— Tight glycemic control with GIK in diabetic CABG patients improves perioperative outcomes, enhances survival, and decreases the incidence of ischemic events and wound complications.
Key Words: insulin • diabetes mellitus • ischemia
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