Glycemic Control in Coronary Revascularization.
Glycemic Control in Coronary Revascularization.
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DOI：
10.1007/s11936-015-0434-6
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发表时间：
2016-02-01
影响因子：
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通讯作者：
Shah, Binita
中科院分区：
文献类型：
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作者：
Ujueta, Francisco;Weiss, Ephraim N;Shah, Binita
观点陈述：在冠状动脉血运重建的情况下，高血糖与患有或未患有糖尿病的患者心血管不良事件增加有关。数据表明，急性围手术期高血糖会导致炎症、血小板活性和内皮功能障碍增加，并与斑块不稳定和梗死面积有关。虽然围手术期血糖水平是接受冠状动脉血运重建患者不良预后的独立预测因素，但治疗策略仍不确定。葡萄糖 - 胰岛素 - 钾输注的随机临床试验一直未显示出益处，而比较胰岛素治疗与标准治疗的试验结果则喜忧参半，这可能是由于这些策略未能实现血糖正常。尽管尚未有降糖药物在围手术期血糖控制方面表现出优越性，但在冠状动脉造影和可能的经皮冠状动脉介入治疗之前，糖尿病患者继续使用临床规定的长效降糖药物可能是维持血糖正常并减少相关炎症和血小板活性增加的最简单和最有效的方法。然而，针对潜在危害机制的治疗（例如，更强效的抗血小板治疗、抗炎治疗）等替代策略也应予以考虑，并值得进一步研究。
OPINION STATEMENT: Hyperglycemia in the setting of coronary revascularization is associated with increased adverse cardiovascular events in patients with or without diabetes mellitus. Data suggest that acute peri-procedural hyperglycemia causes an increase in inflammation, platelet activity, and endothelial dysfunction and is associated with plaque instability and infarct size. While peri-procedural blood glucose level is an independent predictor of adverse outcomes in patients undergoing coronary revascularization, treatment strategies remain uncertain. Randomized clinical trials of glucose-insulin-potassium infusions have consistently shown no benefit, while those comparing insulin therapy versus standard of care have demonstrated mixed results, likely due to the failure to reach euglycemia with these strategies. Although no glucose-lowering agent has been shown to be superior in peri-procedural glycemic control, the continuation of clinically prescribed long-acting glucose-lowering medications in patients with diabetes mellitus prior to coronary angiography and possible percutaneous coronary intervention may be the simplest and most effective approach to maintain euglycemia and decrease the associated increase in inflammation and platelet activity. However, alternative strategies such as therapies targeted at the underlying mechanism of harm (e.g., more potent anti-platelet therapy, anti-inflammatory therapy) should also be considered and warrant further investigation.