Effect of pre-ablation glycated hemoglobin control on outcomes in atrial fibrillation patients with diabetes mellitus following cardiac surgery combined Cox-Maze Ⅳ procedure
10.3760/cma.j.cn112434-20220804-00259
- VernacularTitle:术前糖化血红蛋白控制对心脏外科手术同期Cox-Maze Ⅳ房颤消融术的影响
- Author:
Tianguang WANG
1
;
Kun HUA
;
Yingjian LI
;
Jinwei ZHANG
;
Mingyang ZHOU
;
Xiubin YANG
Author Information
1. 首都医科大学附属北京安贞医院心外科，北京 100029
- Keywords:
Glycated hemoglobin;
Atrial fibrillation;
Cardiac surgery;
Diabetes mellitus;
Atrial fibrillation recurrence
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2023;39(5):303-308
- CountryChina
- Language:Chinese
-
Abstract:
Objective:This study was performed to assess the effect of glycemic control on atrial fibrillation recurrence rates after heart surgery concomitant with Cox-Maze Ⅳ ablation.Methods:A retrospective analysis was performed on 317 diabetic patients with atrial fibrillation who underwent cardiac surgery combined with Cox-Maze Ⅳ ablation in our hospital from May 2016 to February 2020. The patients were followed up for(37.7±27.7) months, and the data of atrial fibrillation recurrence and clinical outcome were collected and compared. The limited cubic spline model was used to analyze the dose-relationship between HbA1c level and the recurrence of atrial fibrillation. The univariate and multivariate Cox proportional regression analysis was used to explore the risk factors of recurrent atrial fibrillation after Cox-Maze Ⅳ ablation. Results:Higher glycated hemoglobin(HbA1c) at the time of ablation was associated with higher post-ablation recurrence rates. The cumulative survival freedom from atrial fibrillation recurrence for patients with HbA1c ≥7.4% at time of operation at 12, 24, 36 and 48 months were 96.3%、75.8%、52.7% and 35.7%, respectively( P<0.001). Besides, the rates of all-cause mortality, cardiac mortality and rehospitalization were significantly lower in patients with HbA1c<7.4%(1.7% vs. 6.3%, P=0.03; 1.1% vs. 5.6%, P=0.02 and 5.7% vs. 20.4%, P=0.01). The multivariate Cox regression model showed that HbA1c was an independent risk factor for atrial fibrillation recurrence( P<0.05). Conclusion:Higher preoperative HbA1c levels were associated with increased recurrence of atrial fibrillation and adverse clinical outcomes in patients undergoing cardiac surgery combined with Cox-Maze Ⅳ ablation.
