Impact of diabetes mellitus on outcomes in Japanese patients undergoing coronary artery bypass grafting
Impact of diabetes mellitus on outcomes in Japanese patients undergoing coronary artery bypass grafting
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DOI：
10.1016/j.jjcc.2011.12.009
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发表时间：
2012-05-01
影响因子：
2.5
通讯作者：
Sakata, Ryuzo
中科院分区：
文献类型：
--
作者：
Minakata, Kenji;Bando, Ko;Sakata, Ryuzo
背景和目的：目前还没有大规模的研究糖尿病（DM）对日本患者接受冠状动脉旁路移植术（CABG）的结果的影响。方法和主题：在14个日本中心进行了多机构回顾性队列研究。纳入了2007年至2008年接受单独CABG的所有成人患者（n=1522，平均年龄：68.5岁）。糖尿病的定义是所有入院诊断为糖尿病且术前糖化血红蛋白（Hb）A1 c ≥ 6.5%的患者。单因素和多因素分析，以确定发病率和死亡率的风险。结果：有849 DM和572非DM患者。DM组术前平均HbA 1c为7.1%，非DM组为5.7%（p < 0.0001）。DM组的术前、术中和术后3天平均血糖（BG）分别为146 mg/dl、172 mg/dl和168 mg/dl，非DM组分别为103 mg/dl、140 mg/dl和136 mg/dl（均p < 0.0001）。尽管术后心血管事件无显著差异，但单变量分析显示，DM组的感染发生率显著高于非DM组（9.2% vs 6.1%，p=0.036）。糖尿病组的全因死亡率也相对高于非糖尿病组（2.1%vs 1.1%，p = 0.12），这可能与感染有关。结论：糖尿病患者围手术期血糖控制较差，感染发生率较高，死亡率高于非糖尿病患者。这些结果表明，围手术期血糖控制指南应标准化，以获得更好的手术结果在日本糖尿病患者。(C)2012年由Elsevier Ltd代表日本心脏病学院发表。
Background and purpose: There have been no large-scale studies on the impact of diabetes mellitus (DM) on outcomes in Japanese patients undergoing coronary artery bypass grafting (CABG).Methods and subjects: A multi-institutional retrospective cohort study was conducted in 14 Japanese centers. All adult patients who underwent isolated CABG from 2007 to 2008 were included (n=1522, mean age: 68.5 years). The definitions of DM were all patients admitted with diagnosis of DM and preoperative glycated hemoglobin (Hb) A1c >= 6.5%. Univariate and multivariate analyses were performed to identify the risk of morbidity and mortality.Results: There were 849 DM and 572 non-DM patients. Preoperative mean HbA1c were 7.1% in the DM group and 5.7% in the non-DM group (p < 0.0001). Preoperative, intraoperative, and 3-day average postoperative blood glucose (BG) were 146 mg/dl, 172 mg/dl, and 168 mg/dl in the DM group, and 103 mg/dl, 140 mg/dl, and 136 mg/dl in the non-DM group (all p < 0.0001). Although there were no significant differences in postoperative cardiovascular events, the incidence of infection was significantly higher in the DM group than in the non-DM group (9.2% vs 6.1%, p=0.036) on the univariate analysis. The all-cause death was also relatively higher in the DM group than in the non-DM group (2.1% vs 1.1%, p = 0.12), and this was likely related to infection.Conclusion: DM patients had worse perioperative BG control, higher incidence of infection, and higher mortality than non-DM patients. These results indicate that perioperative BG control guidelines should be standardized to obtain better surgical outcomes in Japanese DM patients. (C) 2012 Published by Elsevier Ltd on behalf of Japanese College of Cardiology.