Increased glucose variability is associated with atrial fibrillation after coronary artery bypass
Increased glucose variability is associated with atrial fibrillation after coronary artery bypass
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DOI：
10.1111/jocs.14071
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发表时间：
2019-07-01
影响因子：
1.6
通讯作者：
Lawton, Jennifer S.
中科院分区：
文献类型：
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作者：
Clement, Kathleen C.;Alejo, Diane;Lawton, Jennifer S.
背景术前血红蛋白A1 c（HbA 1c）升高是冠状动脉旁路移植术（CABG）后不良结局的预测因子，但术后血糖变异性（GV）升高的作用尚不清楚。我们假设术后短期GV与单纯CABG术后房颤风险增加相关。方法回顾性分析2012年1月至2018年3月2073例接受隔离CABG的患者。术后前24小时的GV通过标准差、变异系数和血糖波动的平均幅度来测量。多因素logistic回归分析评估GV与术后房颤的独立相关性。结果2073例患者符合研究标准，446例（21.5%）患者术后发生房颤。使用多变量logistic回归校正协变量，术后房颤与24小时GV增加（比值比[OR] = 1.16，95%置信区间[CI]，1.05-1.27，P < 0.01）和24小时平均血糖增加（OR = 1.14，95% CI，1.08-1.21，P < 0.01）相关。因此，24小时GV每增加10%或平均血糖每增加10 mg/dL，术后房颤的风险分别增加16%或14%。结论CABG术后24小时GV和平均血糖升高是房颤的预测因子。在调整术后平均血糖和GV后，术前HbA 1c不是术后房颤的风险因素。需要进一步研究以确定严格血糖控制与CABG后不良事件之间的关系。
Background Elevated preoperative hemoglobin A1c (HbA1c) is a predictor of poor outcomes following coronary artery bypass grafting (CABG), but the role of increased postoperative glucose variability (GV) is unknown. We hypothesized that short-term postoperative GV is associated with an increased risk of postoperative atrial fibrillation following isolated CABG. Methods Multicenter retrospective study of 2073 patients who underwent isolated CABG from January 2012 to March 2018. Postoperative GV in the first 24 hours was measured by standard deviation, coefficient of variation, and mean amplitude of glycemic excursions. Multivariate logistic regression assessed the independent association of GV with postoperative atrial fibrillation. Results A total of 2073 patients met the study criteria, and 446 patients (21.5%) developed postoperative atrial fibrillation. Using multivariate logistic regression to adjust for covariates, postoperative atrial fibrillation was associated with increased 24-hour GV (odds ratio [OR] = 1.16, 95% confidence interval [CI], 1.05-1.27, P < 0.01) and increased 24-hour mean glucose (OR = 1.14, 95% CI, 1.08-1.21, P < 0.01). Thus, for every 10% increase in 24-hour GV or 10 mg/dL increase in mean glucose, there was a 16% or 14% increased risk of postoperative atrial fibrillation respectively. Conclusions Increased 24-hour GV and mean glucose are predictors of atrial fibrillation after CABG. Preoperative HbA1c is not a risk factor for postoperative atrial fibrillation after adjusting for postoperative mean glucose and GV. Further investigation is needed to determine the relationship between adherence to strict glucose control and adverse events following CABG.