在患有冠状动脉疾病或心力衰竭的患者中，非心脏手术后的死亡率与糖尿病或降血糖药物均无关。

Neither diabetes nor glucose-lowering drugs are associated with mortality after noncardiac surgery in patients with coronary artery disease or heart failure.

机构信息

Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.

出版信息

Can J Cardiol. 2013 Apr;29(4):423-8. doi: 10.1016/j.cjca.2012.07.004. Epub 2012 Sep 15.

DOI:10.1016/j.cjca.2012.07.004

PMID:22985785

Abstract

BACKGROUND

It is unclear whether diabetes mellitus or use of particular glucose-lowering agents is associated with increased risk of mortality after noncardiac surgery in patients with known cardiac disease.

METHODS

We carried out a retrospective cohort study using 4 linked administrative databases in the province of Alberta, Canada from 1999-2006.

RESULTS

Of the 32,834 patients with known cardiac disease in our cohort, 9305 (28%) had diabetes. All-cause 30-day mortality after noncardiac surgery was 6.4% in patients with diabetes, and 6.1% in those without diabetes (multivariate adjusted odds ratio [aOR] 0.97, 95% confidence interval [CI], 0.87-1.08). In the 24,037 patients older than 65, mortality was 7.5% in individuals with diabetes and 7.5% in those without diabetes (5.7% in those taking insulin [aOR, 0.89; 95% CI, 0.70-1.13], 8.0% in those using oral agents only [aOR, 1.08; 95% CI, 0.95-1.22]). None of the glucose-lowering drug classes were associated with perioperative mortality in elderly cardiac patients (sulfonylureas aOR, 0.94; 95% CI, 0.76-1.16; metformin aOR, 0.92; 95% CI, 0.74-1.14; thiazolidinediones aOR, 0.64; 95% CI, 0.40-1.04; insulin aOR, 0.83; 95% CI, 0.65-1.08), but use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (aOR, 0.83; 95% CI, 0.75-0.93), β-blockers (aOR, 0.82; 95% CI, 0.72-0.93), or statins (aOR, 0.65; 95% CI, 0.55-0.78) in the 100 days before surgery were associated with lower 30-day mortality.

CONCLUSIONS

Neither diabetes nor exposure to common classes of glucose-lowering drugs preoperatively were associated with increased perioperative mortality in cardiac patients undergoing noncardiac surgery. However, cardiac patients not using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, or statins preoperatively exhibited higher mortality rates, emphasizing the importance of optimizing evidence-based therapy before elective surgery in these patients.

摘要

背景

患有已知心脏病的患者在非心脏手术后，糖尿病或特定的降血糖药物的使用与死亡率增加之间的关系尚不清楚。

方法

我们使用加拿大艾伯塔省的 4 个行政数据库进行了一项回顾性队列研究，时间为 1999 年至 2006 年。

结果

在我们的队列中，32834 名患有已知心脏病的患者中，有 9305 名（28%）患有糖尿病。非心脏手术后 30 天的全因死亡率在糖尿病患者中为 6.4%，在无糖尿病患者中为 6.1%（多变量调整后比值比[aOR]0.97，95%置信区间[CI]0.87-1.08）。在年龄大于 65 岁的 24037 名患者中，糖尿病患者的死亡率为 7.5%，无糖尿病患者的死亡率为 7.5%（使用胰岛素的患者为 5.7%[aOR，0.89；95%CI，0.70-1.13]，仅使用口服药物的患者为 8.0%[aOR，1.08；95%CI，0.95-1.22]）。在老年心脏病患者中，没有任何降糖药物类别与围手术期死亡率相关（磺酰脲类 aOR，0.94；95%CI，0.76-1.16；二甲双胍 aOR，0.92；95%CI，0.74-1.14；噻唑烷二酮类 aOR，0.64；95%CI，0.40-1.04；胰岛素 aOR，0.83；95%CI，0.65-1.08），但在术前 100 天使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（aOR，0.83；95%CI，0.75-0.93）、β受体阻滞剂（aOR，0.82；95%CI，0.72-0.93）或他汀类药物（aOR，0.65；95%CI，0.55-0.78）与 30 天死亡率降低相关。