胰岛素治疗和非胰岛素治疗糖尿病患者冠状动脉旁路移植术的当代疗效

Contemporary Outcomes of Coronary Artery Bypass Grafting Among Patients With Insulin-Treated and Non-Insulin-Treated Diabetes.

作者信息

Li Zhongmin, Amsterdam Ezra A, Young J Nilas, Hoegh Holly, Armstrong Ehrin J

机构信息

University of California, Davis Medical Center, Sacramento, California.

出版信息

Ann Thorac Surg. 2015 Dec;100(6):2262-9. doi: 10.1016/j.athoracsur.2015.06.028. Epub 2015 Aug 25.

DOI:10.1016/j.athoracsur.2015.06.028

PMID:26319487

Abstract

BACKGROUND

More than 40% of patients undergoing coronary artery bypass grafting (CABG) have diabetes. However, it is unknown how insulin treatment status influences cardiac surgical outcomes among patients with diabetes.

METHODS

All isolated CABG, CABG plus aortic valve replacement or plus mitral valve repair/replacement procedures performed in 2012 were extracted from the California CABG Outcomes Reporting Program database. Patients were grouped into three categories: (1) no diabetes, (2) non-insulin-treated diabetes (NITDM), and (3) insulin-treated diabetes (ITDM). Demographic and clinical baseline characteristics and observed postoperative major adverse events, including 30-day mortality, stroke, deep sternal wound infection, prolonged ventilation, new dialysis requirement, renal failure, and 30-day readmission were compared. Multivariable logistic regression models were developed for predicting the impact of NITDM and ITDM on postoperative major adverse events.

RESULTS

A total of 14,051 patients underwent isolated CABG or CABG plus aortic/mitral valve procedures in California during 2012; 6700 (47.7%) had no diabetes, 5165 (36.8%) had NITDM, and 2183 (15.6%) had ITDM. Compared with the nondiabetic and NITDM groups, the ITDM group was younger, more frequently women and nonwhite, and had a higher prevalence of preoperative comorbidities (all p < 0.05). After adjusting for baseline risk factors and surgery type compared with patients without diabetes, both NITDM and ITDM were associated with significantly increased risk of major adverse events [NITDM: adjusted odds ratio (AOR), 1.15, 95 % confidence interval (CI), 1.04 to 1.26, p = 0.005; ITDM: AOR, 1.49, 95% CI, 1.32 to 1.68, p < 0.0001]. A subgroup comparison indicated a similar gradient of risk for each category of cardiac surgery.

CONCLUSIONS

Patients with diabetes undergoing CABG have substantially increased risk of major adverse events. Patients with ITDM represent an especially high-risk group.

摘要

背景

超过40%接受冠状动脉旁路移植术（CABG）的患者患有糖尿病。然而，胰岛素治疗状态如何影响糖尿病患者的心脏手术结局尚不清楚。

方法

从加利福尼亚CABG结局报告项目数据库中提取2012年进行的所有单纯CABG、CABG加主动脉瓣置换术或加二尖瓣修复/置换术。患者分为三类：（1）无糖尿病，（2）非胰岛素治疗糖尿病（NITDM），（3）胰岛素治疗糖尿病（ITDM）。比较人口统计学和临床基线特征以及观察到的术后主要不良事件，包括30天死亡率、中风、深部胸骨伤口感染、通气时间延长、新的透析需求、肾衰竭和30天再入院率。建立多变量逻辑回归模型以预测NITDM和ITDM对术后主要不良事件的影响。

结果

2012年加利福尼亚共有14051例患者接受了单纯CABG或CABG加主动脉/二尖瓣手术；6700例（47.7%）无糖尿病，5165例（36.8%）患有NITDM，2183例（15.6%）患有ITDM。与非糖尿病组和NITDM组相比，ITDM组更年轻，女性和非白人更常见，术前合并症患病率更高（所有p<0.05）。在调整基线风险因素和手术类型后，与无糖尿病患者相比，NITDM和ITDM均与主要不良事件风险显著增加相关[NITDM：调整后的优势比（AOR），1.15，95%置信区间（CI），1.04至1.26，p=0.005；ITDM：AOR，1.49，95%CI，1.32至1.68，p<0.0001]。亚组比较表明，每种心脏手术类型的风险梯度相似。