Relationship Between Diabetic Variables and Outcomes After Coronary Artery Bypass Grafting in Diabetic Patients
Relationship Between Diabetic Variables and Outcomes After Coronary Artery Bypass Grafting in Diabetic Patients
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DOI：
10.1016/j.hlc.2016.05.117
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发表时间：
2017-04-01
影响因子：
2.6
通讯作者：
Pemberton, James
中科院分区：
文献类型：
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作者：
Wang, Tom Kai Ming;Woodhead, Andrew;Pemberton, James
近一半接受冠状动脉旁路移植术（CABG）的患者患有糖尿病。术前（血红蛋白A1c{HbA1c}）和/或围手术期糖尿病控制是否与冠脉搭桥后的死亡率和发病率相关，数据不一。我们回顾了接受CABG的糖尿病患者的特点和结局，重点是HbA1c、围手术期血糖水平和糖尿病治疗方案。方法选取2010年7月~ 2012年6月行冠脉搭桥的糖尿病患者306例。回顾性记录最后一次术前HbA1c水平和围手术期血糖水平（平均值和变异系数{CV}），以及既往和围手术期糖尿病治疗方案进行分析。结果平均HbA1c为7.7+/-1.6%，术前仅使用饮食、口服糖尿病药物和胰岛素治疗的患者分别为11.1%（34）、56.2%（172）和32.7%（100）。对于2.0%的手术死亡率，c -统计（95%可信区间）仅在HbA1c为0.855(0.757-0.975)，手术当日葡萄糖CV为0.722（0.567-0.877）有统计学意义。HbA1c还可检测到术后肾功能衰竭，c统计值为0.617(0.504-0.730)，但随访期间未发现其他并发症或死亡率。在多变量分析中，HbA1c是唯一与糖尿病相关的手术死亡率的独立预测因子，危险比为4.13(1.04-16.4)，没有糖尿病相关的变量预测随访期间的死亡率或其他术后并发症。结论术前HbA1c是唯一独立预测CABG术后死亡率的糖尿病变量，提示术前中期糖尿病控制比围手术期糖尿病控制更重要，对手术预后影响更大。
Background Nearly half of the patients undergoing coronary artery bypass grafting (CABG) have diabetes. There is mixed data as to whether preoperative (haemoglobin A1c{HbA1c}) and/or perioperative diabetes control is associated with mortality and morbidity after CABG. We reviewed the characteristics and outcomes of diabetic patients undergoing CABG with a focus on HbA1c, perioperative glucose levels and diabetic treatment regimens.Methods Diabetic patients undergoing CABG during July 2010 to June 2012 were studied (n= 306). The last preoperative HbA1c levels, and perioperative glucose levels (mean and coefficient of variation {CV}) were retrospectively recorded, as well as the pre-existing and perioperative diabetes treatment regimens for analyses.Results Mean HbA1c was 7.7+/-1.6%, and 11.1% (34), 56.2% (172), and 32.7% (100) of patients were managed preoperatively with diet only, oral diabetic medications and insulin respectively. For operative mortality which occurred in 2.0%, C-statistics (95% confidence interval) was only significant for HbA1c, 0.855 (0.757-0.975), and glucose CV on the day of surgery, 0.722 (0.567-0.877). HbA1c also detected postoperative renal failure, C-statistic 0.617 (0.504-0.730), but not other complications or mortality during follow-up. In multivariate analysis, HbA1c was the only diabetes-related independent predictor of operative mortality, hazards ratio 4.13 (1.04-16.4), and none of the diabetes-related variables predicted mortality during follow-up or other postoperative complications.Conclusion Preoperative HbA1c was the only diabetic variable to independently predict operative mortality after CABG, suggesting medium-term preoperative diabetes control is more important and prognostic of operative outcomes than perioperative diabetes control.