Feringa H H H, Vidakovic R, Karagiannis S E, Dunkelgrun M, Elhendy A, Boersma E, van Sambeek M R H M, Noordzij P G, Bax J J, Poldermans D
Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
Diabet Med. 2008 Mar;25(3):314-9. doi: 10.1111/j.1464-5491.2007.02352.x. Epub 2008 Jan 14.
Cardiac morbidity and mortality is high in patients undergoing high-risk surgery. This study investigated whether impaired glucose regulation and elevated glycated haemoglobin (HbA(1c)) levels are associated with increased cardiac ischaemic events in vascular surgery patients.
Baseline glucose and HbA(1c) were measured in 401 vascular surgery patients. Glucose < 5.6 mmol/l was defined as normal. Fasting glucose 5.6-7.0 mmol/l or random glucose 5.6-11.1 mmol/l was defined as impaired glucose regulation. Fasting glucose > or = 7.0 or random glucose > or = 11.1 mmol/l was defined as diabetes. Perioperative ischaemia was identified by 72-h Holter monitoring. Troponin T was measured on days 1, 3 and 7 and before discharge. Cardiac death or Q-wave myocardial infarction was noted at 30-day and longer-term follow-up (mean 2.5 years).
Mean (+/- sd) level for glucose was 6.3 +/- 2.3 mmol/l and for HbA(1c) 6.2 +/- 1.3%. Ischaemia, troponin release, 30-day and long-term cardiac events occurred in 27, 22, 6 and 17%, respectively. Using subjects with normal glucose levels as the reference category, multivariate analysis revealed that patients with impaired glucose regulation and diabetes were at 2.2- and 2.6-fold increased risk of ischaemia, 3.8- and 3.9-fold for troponin release, 4.3- and 4.8-fold for 30-day cardiac events and 1.9- and 3.1-fold for long-term cardiac events. Patients with HbA(1c) > 7.0% (n = 63, 16%) were at 2.8-fold, 2.1-fold, 5.3-fold and 5.6-fold increased risk for ischaemia, troponin release, 30-day and long-term cardiac events, respectively.
Impaired glucose regulation and elevated HbA(1c) are risk factors for cardiac ischaemic events in vascular surgery patients.
接受高风险手术的患者心脏发病和死亡率较高。本研究调查了血管手术患者中葡萄糖调节受损和糖化血红蛋白（HbA1c）水平升高是否与心脏缺血事件增加相关。
对401例血管手术患者测量基线血糖和HbA1c。血糖<5.6 mmol/L定义为正常。空腹血糖5.6 - 7.0 mmol/L或随机血糖5.6 - 11.1 mmol/L定义为葡萄糖调节受损。空腹血糖≥7.0或随机血糖≥11.1 mmol/L定义为糖尿病。通过72小时动态心电图监测识别围手术期缺血。在第1、3、7天及出院前测量肌钙蛋白T。在30天及长期随访（平均2.5年）时记录心脏死亡或Q波心肌梗死。
血糖的平均（±标准差）水平为6.3±2.3 mmol/L，HbA1c为6.2±1.3%。缺血、肌钙蛋白释放、30天和长期心脏事件的发生率分别为27%、22%、6%和17%。以血糖水平正常的受试者作为参照组，多因素分析显示，葡萄糖调节受损和糖尿病患者发生缺血的风险分别增加2.2倍和2.6倍，肌钙蛋白释放增加3.8倍和3.9倍，30天心脏事件增加4.3倍和4.8倍，长期心脏事件增加1.9倍和3.1倍。HbA1c>7.0%的患者（n = 63，16%）发生缺血、肌钙蛋白释放、30天和长期心脏事件的风险分别增加2.8倍、2.1倍、5.3倍和5.6倍。
葡萄糖调节受损和HbA1c升高是血管手术患者心脏缺血事件的危险因素。
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