AUTHOR=Knochenhauer Tim , Schaefer Andreas , Brickwedel Jens , Reiter Beate , Naito Shiho , Zipfel Svante , Schneeberger Yvonne , Reichenspurner Hermann , Sill Bjoern 

TITLE=Association of HbA1c and utilization of internal mammary arteries with wound infections in CABG

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1345726

DOI=10.3389/fcvm.2024.1345726

ISSN=2297-055X

ABSTRACT=Background: Deep sternal wound infection (DSWI) remains a serious complication after coronary artery bypass grafting (CABG). We herein aimed to stratify diabetic patients who underwent CABG using BIMA for levels of glycated hemoglobin A1c (HbA1C) and compare postoperative outcomes.Methods: Between 01/2010 and 08/2020, 4186 consecutive patients underwent isolated CABG at our center. In 3229 patients preoperative HbA1c levels were available. Primary endpoints were wound healing disorder (WHD), DSWI and 30-day mortality. Patients were stratified according to preoperative HbA1c levels. Patients were further divided into subgroups according to utilization of BIMA.Results: After adjustment no differences in mortality and stroke rates were seen between group 1 (HbA1c˂6.5%) vs. group 2 (HbA1c≥6.5%). WHD was more frequent in group 2 (2.8 vs. 5.6%; adjusted p = 0.002; adjusted OR 1.853 [1.243 -2.711]) but not DSWI (1.0 vs. 1.5%; adjusted p = 0.543; adjusted OR 1.247 [0.612 -2.5409). BIMA use showed a higher rate of WHD (no BIMA: 3.0%; BIMA: 7.7%; adjusted p = 0.002; adjusted OR 4.766 (1.747 -13.002))but not DSWI (no BIMA: 1.1%; BIMA: 1.8%; adjusted p = 0.615; adjusted OR 1.591 (0.260 -9.749)) in patients with HbA1c≥6.5%.Intraoperative utilization of BIMA is not connected with an increase of DSWI but higher rates of WHD in patients with poor diabetic status and HbA1c≥6.5%. Therefore, application of BIMA should be taken into consideration even in patients with poor diabetic status, while identification of special subsets of patients which are at particular high risk for DSWI is of paramount importance to prevent this serious complication.