McGinn Joseph T, Shariff Masood A, Bhat Tariq M, Azab Basem, Molloy William J, Quattrocchi Elaena, Farid Mina, Eichorn Ann M, Dlugacz Yosef D, Silverman Robert A
Cardiothoracic Surgery Department, Heart Institute at Staten Island University Hospital, 475 Seaview Ave, Staten Island, New York, USA.
J Cardiothorac Surg. 2011 Sep 2;6:104. doi: 10.1186/1749-8090-6-104.
Dysglycemia is a major risk factor for atherosclerosis. In many patient populations dysglycemia is under-diagnosed. Patients with severe coronary artery disease commonly have dysglycemia and there is growing evidence that dysglycemia, irrespective of underlying history of diabetes, is associated with adverse outcome in coronary artery bypass graft (CABG) surgery patients, including longer hospital stay, wound infections, and higher mortality. As HbA1c is an easy and reliable way of checking for dysglycemia we routinely screen all patients undergoing CABG for elevations in HbA1c. Our hypothesis was that a substantial number of patients with dysglycemia that could be identified at the time of cardiothoracic surgery despite having no apparent history of diabetes.
1045 consecutive patients undergoing CABG between 2007 and 2009 had HbA1c measured pre-operatively. The 2010 American Diabetes Association (ADA) diagnostic guidelines were used to categorize patients with no known history of diabetes as having diabetes (HbA1c ≥ 6.5%) or increased risk for diabetes (HbA1c 5.7-6.4%).
Of the 1045 patients with pre-operative HbA1c measurements, 40% (n = 415) had a known history of diabetes and 60% (n = 630) had no known history of diabetes. For the 630 patients with no known diabetic history: 207 (32.9%) had a normal HbA1c (< 5.7%); 356 (56.5%) had an HbA1c falling in the increased risk for diabetes range (5.7-6.4%); and 67 (10.6%) had an HbA1c in the diabetes range (6.5% or higher). In this study the only conventional risk factor that was predictive of high HbA1c was BMI. We also found a high HbA1c irrespective of history of DM was associated with severe coronary artery disease as indicated by the number of vessels revascularized.
Among individuals undergoing CABG with no known history of diabetes, there is a substantial amount of undiagnosed dysglycemia. Even though labeling these patients as "diabetic" or "increased risk for diabetes" remains controversial in terms of perioperative management, pre-operative screening could lead to appropriate post-operative follow up to mitigate short-term adverse outcome and provide high priority medical referrals of this at risk population.
血糖异常是动脉粥样硬化的主要危险因素。在许多患者群体中，血糖异常未得到充分诊断。严重冠状动脉疾病患者通常存在血糖异常，并且越来越多的证据表明，无论潜在的糖尿病病史如何，血糖异常与冠状动脉搭桥术（CABG）患者的不良结局相关，包括住院时间延长、伤口感染和更高的死亡率。由于糖化血红蛋白（HbA1c）是检查血糖异常的一种简单可靠的方法，我们常规筛查所有接受CABG手术的患者的HbA1c升高情况。我们的假设是，尽管没有明显的糖尿病病史，但在心胸外科手术时仍可识别出大量血糖异常患者。
对2007年至2009年间连续接受CABG手术的1045例患者进行术前HbA1c测量。采用2010年美国糖尿病协会（ADA）诊断指南将无已知糖尿病病史的患者分类为患有糖尿病（HbA1c≥6.5%）或糖尿病风险增加（HbA1c 5.7 - 6.4%）。
在1045例进行术前HbA1c测量的患者中，40%（n = 415）有已知糖尿病病史，60%（n = 630）无已知糖尿病病史。对于630例无已知糖尿病病史的患者：207例（32.9%）HbA1c正常（<5.7%）；356例（56.5%）HbA1c处于糖尿病风险增加范围（5.7 - 6.4%）；67例（10.6%）HbA1c处于糖尿病范围（6.5%或更高）。在本研究中，唯一可预测高HbA1c的传统危险因素是体重指数（BMI）。我们还发现，无论糖尿病病史如何，高HbA1c与血管重建的血管数量所表明的严重冠状动脉疾病相关。
在无已知糖尿病病史的接受CABG手术的个体中，存在大量未被诊断的血糖异常。尽管就围手术期管理而言，将这些患者标记为 “糖尿病患者” 或 “糖尿病风险增加” 仍存在争议，但术前筛查可导致适当的术后随访，以减轻短期不良结局，并为这一高危人群提供高度优先的医疗转诊。
