The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Vinod H Thourani - One of the best experts on this subject based on the ideXlab platform.
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elevated preoperative Hemoglobin A1c level is associated with reduced long term survival after coronary artery bypass surgery
The Annals of Thoracic Surgery, 2008Co-Authors: Michael E Halkos, John D Puskas, Omar M Lattouf, Patrick D Kilgo, Robert A Guyton, William A Cooper, Cullen D Morris, Vinod H ThouraniAbstract:Background The predictive role of Hemoglobin A1c (HbA1c) on long-term outcomes after coronary artery bypass surgery has not been evaluated. Methods Preoperative HbA1c levels were obtained in 3,201 patients undergoing primary, elective coronary artery bypass surgery at Emory Healthcare Hospitals from January 2002 to December 2006 and entered prospectively into a computerized database. Long-term survival status was determined by cross-referencing patient records with the Social Security Death Index. Log-rank (unadjusted) and Cox proportional hazards regression models (adjusted) were employed to determine whether HbA1c and diabetes mellitus were independent risk factors for reduced long-term survival, adjusted for 29 covariates. Hazard ratios for each unit increase in continuous HbA1c were calculated. Results Patients with HbA1c of 7% or greater had lower unadjusted 5-year survival compared with patients with HbA1c less than 7% (p = 0.001). Similarly, patients with diabetes mellitus had lower unadjusted 5-year survival compared with patients without diabetes (p Conclusions Poor preoperative glycemic control, as measured by an elevated HbA1c, is associated with reduced long-term survival after coronary artery bypass surgery. Optimizing glucose control in these patients may improve long-term survival.
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elevated preoperative Hemoglobin A1c level is predictive of adverse events after coronary artery bypass surgery
The Journal of Thoracic and Cardiovascular Surgery, 2008Co-Authors: Michael E Halkos, John D Puskas, Omar M Lattouf, Patrick D Kilgo, Faraz Kerendi, Howard K Song, Robert A Guyton, Vinod H ThouraniAbstract:Objective Diabetes mellitus has been associated with an increased risk of adverse outcomes after coronary artery bypass grafting. Hemoglobin A1c is a reliable measure of long-term glucose control. It is unknown whether adequacy of diabetic control, measured by Hemoglobin A1c, is a predictor of adverse outcomes after coronary artery bypass grafting. Methods Of 3555 consecutive patients who underwent primary, elective coronary artery bypass grafting at a single academic center from April 1, 2002, to June 30, 2006, 3089 (86.9%) had preoperative Hemoglobin A1c levels obtained and entered prospectively into a computerized database. All patients were treated with a perioperative intravenous insulin protocol. A multivariable logistic regression model was used to determine whether Hemoglobin A1c, as a continuous variable, was associated with in-hospital mortality, renal failure, cerebrovascular accident, myocardial infarction, and deep sternal wound infection after coronary artery bypass grafting. Receiver operating characteristic curve analysis identified the Hemoglobin A1c value that maximally discriminated outcome dichotomies. Results In-hospital mortality for all patients was 1.0% (31/3089). An elevated Hemoglobin A1c level predicted in-hospital mortality after coronary artery bypass grafting (odds ratio 1.40 per unit increase, P = .019). Receiver operating characteristic curve analysis revealed that Hemoglobin A1c greater than 8.6% was associated with a 4-fold increase in mortality. For each unit increase in Hemoglobin A1c, there was a significantly increased risk of myocardial infarction and deep sternal wound infection. By using receiver operating characteristic value thresholds, renal failure (threshold 6.7, odds ratio 2.1), cerebrovascular accident (threshold 7.6, odds ratio 2.24), and deep sternal wound infection (threshold 7.8, odds ratio 5.29) occurred more commonly in patients with elevated Hemoglobin A1c. Conclusion Elevated Hemoglobin A1c level was strongly associated with adverse events after coronary artery bypass grafting. Preoperative Hemoglobin A1c testing may allow for more accurate risk stratification in patients undergoing coronary artery bypass grafting.
Edith Miller - One of the best experts on this subject based on the ideXlab platform.
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Hemoglobin A1c and postpartum abnormal glucose tolerance among women with gestational diabetes mellitus
Obstetrics & Gynecology, 2012Co-Authors: Jodie G Katon, Gayle E Reiber, Michelle A Williams, David Yanez, Edith MillerAbstract:OBJECTIVE To analyze the association of Hemoglobin A1c (HbA1c) at gestational diabetes mellitus (GDM) diagnosis with postpartum abnormal glucose in a cohort of women with GDM. METHODS Women with singleton pregnancies treated for GDM at a large diabetes and pregnancy program located in Charlotte, North Carolina, who completed a postpartum 2-hour oral glucose tolerance test were eligible for inclusion in this retrospective cohort study. Clinical information, including maternal HbA1c at diagnosis, was abstracted from medical records. A parametric survival model was used to assess the association of HbA1c at GDM diagnosis with postpartum maternal abnormal glucose including impaired fasting glucose, impaired glucose tolerance, and any postpartum abnormal glucose. RESULTS Of the 277 postpartum women with GDM, 75 (32%) had impaired fasting glucose, 61 (28%) had impaired glucose tolerance, and 15 (9%) were diagnosed with type 2 diabetes mellitus after delivery. After adjustment for clinic, maternal age, parity, prepregnancy body mass index 25 or higher, nonwhite race or ethnicity, and gestational week at first HbA1c, we detected a trend of increased risk for impaired fasting glucose (P=.01), impaired glucose tolerance (P=.002), and any glucose abnormality (P<.001) associated with increased quartile of HbA1c at GDM diagnosis. CONCLUSION Hemoglobin A1c measured at GDM diagnosis may be a useful tool for identifying patients with GDM at highest risk of developing postpartum abnormal glucose.
Michael E Halkos - One of the best experts on this subject based on the ideXlab platform.
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elevated preoperative Hemoglobin A1c level is associated with reduced long term survival after coronary artery bypass surgery
The Annals of Thoracic Surgery, 2008Co-Authors: Michael E Halkos, John D Puskas, Omar M Lattouf, Patrick D Kilgo, Robert A Guyton, William A Cooper, Cullen D Morris, Vinod H ThouraniAbstract:Background The predictive role of Hemoglobin A1c (HbA1c) on long-term outcomes after coronary artery bypass surgery has not been evaluated. Methods Preoperative HbA1c levels were obtained in 3,201 patients undergoing primary, elective coronary artery bypass surgery at Emory Healthcare Hospitals from January 2002 to December 2006 and entered prospectively into a computerized database. Long-term survival status was determined by cross-referencing patient records with the Social Security Death Index. Log-rank (unadjusted) and Cox proportional hazards regression models (adjusted) were employed to determine whether HbA1c and diabetes mellitus were independent risk factors for reduced long-term survival, adjusted for 29 covariates. Hazard ratios for each unit increase in continuous HbA1c were calculated. Results Patients with HbA1c of 7% or greater had lower unadjusted 5-year survival compared with patients with HbA1c less than 7% (p = 0.001). Similarly, patients with diabetes mellitus had lower unadjusted 5-year survival compared with patients without diabetes (p Conclusions Poor preoperative glycemic control, as measured by an elevated HbA1c, is associated with reduced long-term survival after coronary artery bypass surgery. Optimizing glucose control in these patients may improve long-term survival.
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elevated preoperative Hemoglobin A1c level is predictive of adverse events after coronary artery bypass surgery
The Journal of Thoracic and Cardiovascular Surgery, 2008Co-Authors: Michael E Halkos, John D Puskas, Omar M Lattouf, Patrick D Kilgo, Faraz Kerendi, Howard K Song, Robert A Guyton, Vinod H ThouraniAbstract:Objective Diabetes mellitus has been associated with an increased risk of adverse outcomes after coronary artery bypass grafting. Hemoglobin A1c is a reliable measure of long-term glucose control. It is unknown whether adequacy of diabetic control, measured by Hemoglobin A1c, is a predictor of adverse outcomes after coronary artery bypass grafting. Methods Of 3555 consecutive patients who underwent primary, elective coronary artery bypass grafting at a single academic center from April 1, 2002, to June 30, 2006, 3089 (86.9%) had preoperative Hemoglobin A1c levels obtained and entered prospectively into a computerized database. All patients were treated with a perioperative intravenous insulin protocol. A multivariable logistic regression model was used to determine whether Hemoglobin A1c, as a continuous variable, was associated with in-hospital mortality, renal failure, cerebrovascular accident, myocardial infarction, and deep sternal wound infection after coronary artery bypass grafting. Receiver operating characteristic curve analysis identified the Hemoglobin A1c value that maximally discriminated outcome dichotomies. Results In-hospital mortality for all patients was 1.0% (31/3089). An elevated Hemoglobin A1c level predicted in-hospital mortality after coronary artery bypass grafting (odds ratio 1.40 per unit increase, P = .019). Receiver operating characteristic curve analysis revealed that Hemoglobin A1c greater than 8.6% was associated with a 4-fold increase in mortality. For each unit increase in Hemoglobin A1c, there was a significantly increased risk of myocardial infarction and deep sternal wound infection. By using receiver operating characteristic value thresholds, renal failure (threshold 6.7, odds ratio 2.1), cerebrovascular accident (threshold 7.6, odds ratio 2.24), and deep sternal wound infection (threshold 7.8, odds ratio 5.29) occurred more commonly in patients with elevated Hemoglobin A1c. Conclusion Elevated Hemoglobin A1c level was strongly associated with adverse events after coronary artery bypass grafting. Preoperative Hemoglobin A1c testing may allow for more accurate risk stratification in patients undergoing coronary artery bypass grafting.
Robert A Guyton - One of the best experts on this subject based on the ideXlab platform.
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elevated preoperative Hemoglobin A1c level is associated with reduced long term survival after coronary artery bypass surgery
The Annals of Thoracic Surgery, 2008Co-Authors: Michael E Halkos, John D Puskas, Omar M Lattouf, Patrick D Kilgo, Robert A Guyton, William A Cooper, Cullen D Morris, Vinod H ThouraniAbstract:Background The predictive role of Hemoglobin A1c (HbA1c) on long-term outcomes after coronary artery bypass surgery has not been evaluated. Methods Preoperative HbA1c levels were obtained in 3,201 patients undergoing primary, elective coronary artery bypass surgery at Emory Healthcare Hospitals from January 2002 to December 2006 and entered prospectively into a computerized database. Long-term survival status was determined by cross-referencing patient records with the Social Security Death Index. Log-rank (unadjusted) and Cox proportional hazards regression models (adjusted) were employed to determine whether HbA1c and diabetes mellitus were independent risk factors for reduced long-term survival, adjusted for 29 covariates. Hazard ratios for each unit increase in continuous HbA1c were calculated. Results Patients with HbA1c of 7% or greater had lower unadjusted 5-year survival compared with patients with HbA1c less than 7% (p = 0.001). Similarly, patients with diabetes mellitus had lower unadjusted 5-year survival compared with patients without diabetes (p Conclusions Poor preoperative glycemic control, as measured by an elevated HbA1c, is associated with reduced long-term survival after coronary artery bypass surgery. Optimizing glucose control in these patients may improve long-term survival.
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elevated preoperative Hemoglobin A1c level is predictive of adverse events after coronary artery bypass surgery
The Journal of Thoracic and Cardiovascular Surgery, 2008Co-Authors: Michael E Halkos, John D Puskas, Omar M Lattouf, Patrick D Kilgo, Faraz Kerendi, Howard K Song, Robert A Guyton, Vinod H ThouraniAbstract:Objective Diabetes mellitus has been associated with an increased risk of adverse outcomes after coronary artery bypass grafting. Hemoglobin A1c is a reliable measure of long-term glucose control. It is unknown whether adequacy of diabetic control, measured by Hemoglobin A1c, is a predictor of adverse outcomes after coronary artery bypass grafting. Methods Of 3555 consecutive patients who underwent primary, elective coronary artery bypass grafting at a single academic center from April 1, 2002, to June 30, 2006, 3089 (86.9%) had preoperative Hemoglobin A1c levels obtained and entered prospectively into a computerized database. All patients were treated with a perioperative intravenous insulin protocol. A multivariable logistic regression model was used to determine whether Hemoglobin A1c, as a continuous variable, was associated with in-hospital mortality, renal failure, cerebrovascular accident, myocardial infarction, and deep sternal wound infection after coronary artery bypass grafting. Receiver operating characteristic curve analysis identified the Hemoglobin A1c value that maximally discriminated outcome dichotomies. Results In-hospital mortality for all patients was 1.0% (31/3089). An elevated Hemoglobin A1c level predicted in-hospital mortality after coronary artery bypass grafting (odds ratio 1.40 per unit increase, P = .019). Receiver operating characteristic curve analysis revealed that Hemoglobin A1c greater than 8.6% was associated with a 4-fold increase in mortality. For each unit increase in Hemoglobin A1c, there was a significantly increased risk of myocardial infarction and deep sternal wound infection. By using receiver operating characteristic value thresholds, renal failure (threshold 6.7, odds ratio 2.1), cerebrovascular accident (threshold 7.6, odds ratio 2.24), and deep sternal wound infection (threshold 7.8, odds ratio 5.29) occurred more commonly in patients with elevated Hemoglobin A1c. Conclusion Elevated Hemoglobin A1c level was strongly associated with adverse events after coronary artery bypass grafting. Preoperative Hemoglobin A1c testing may allow for more accurate risk stratification in patients undergoing coronary artery bypass grafting.
John D Puskas - One of the best experts on this subject based on the ideXlab platform.
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elevated preoperative Hemoglobin A1c level is associated with reduced long term survival after coronary artery bypass surgery
The Annals of Thoracic Surgery, 2008Co-Authors: Michael E Halkos, John D Puskas, Omar M Lattouf, Patrick D Kilgo, Robert A Guyton, William A Cooper, Cullen D Morris, Vinod H ThouraniAbstract:Background The predictive role of Hemoglobin A1c (HbA1c) on long-term outcomes after coronary artery bypass surgery has not been evaluated. Methods Preoperative HbA1c levels were obtained in 3,201 patients undergoing primary, elective coronary artery bypass surgery at Emory Healthcare Hospitals from January 2002 to December 2006 and entered prospectively into a computerized database. Long-term survival status was determined by cross-referencing patient records with the Social Security Death Index. Log-rank (unadjusted) and Cox proportional hazards regression models (adjusted) were employed to determine whether HbA1c and diabetes mellitus were independent risk factors for reduced long-term survival, adjusted for 29 covariates. Hazard ratios for each unit increase in continuous HbA1c were calculated. Results Patients with HbA1c of 7% or greater had lower unadjusted 5-year survival compared with patients with HbA1c less than 7% (p = 0.001). Similarly, patients with diabetes mellitus had lower unadjusted 5-year survival compared with patients without diabetes (p Conclusions Poor preoperative glycemic control, as measured by an elevated HbA1c, is associated with reduced long-term survival after coronary artery bypass surgery. Optimizing glucose control in these patients may improve long-term survival.
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elevated preoperative Hemoglobin A1c level is predictive of adverse events after coronary artery bypass surgery
The Journal of Thoracic and Cardiovascular Surgery, 2008Co-Authors: Michael E Halkos, John D Puskas, Omar M Lattouf, Patrick D Kilgo, Faraz Kerendi, Howard K Song, Robert A Guyton, Vinod H ThouraniAbstract:Objective Diabetes mellitus has been associated with an increased risk of adverse outcomes after coronary artery bypass grafting. Hemoglobin A1c is a reliable measure of long-term glucose control. It is unknown whether adequacy of diabetic control, measured by Hemoglobin A1c, is a predictor of adverse outcomes after coronary artery bypass grafting. Methods Of 3555 consecutive patients who underwent primary, elective coronary artery bypass grafting at a single academic center from April 1, 2002, to June 30, 2006, 3089 (86.9%) had preoperative Hemoglobin A1c levels obtained and entered prospectively into a computerized database. All patients were treated with a perioperative intravenous insulin protocol. A multivariable logistic regression model was used to determine whether Hemoglobin A1c, as a continuous variable, was associated with in-hospital mortality, renal failure, cerebrovascular accident, myocardial infarction, and deep sternal wound infection after coronary artery bypass grafting. Receiver operating characteristic curve analysis identified the Hemoglobin A1c value that maximally discriminated outcome dichotomies. Results In-hospital mortality for all patients was 1.0% (31/3089). An elevated Hemoglobin A1c level predicted in-hospital mortality after coronary artery bypass grafting (odds ratio 1.40 per unit increase, P = .019). Receiver operating characteristic curve analysis revealed that Hemoglobin A1c greater than 8.6% was associated with a 4-fold increase in mortality. For each unit increase in Hemoglobin A1c, there was a significantly increased risk of myocardial infarction and deep sternal wound infection. By using receiver operating characteristic value thresholds, renal failure (threshold 6.7, odds ratio 2.1), cerebrovascular accident (threshold 7.6, odds ratio 2.24), and deep sternal wound infection (threshold 7.8, odds ratio 5.29) occurred more commonly in patients with elevated Hemoglobin A1c. Conclusion Elevated Hemoglobin A1c level was strongly associated with adverse events after coronary artery bypass grafting. Preoperative Hemoglobin A1c testing may allow for more accurate risk stratification in patients undergoing coronary artery bypass grafting.