Endocrinology and Cardiovascular Metabolism Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
J Diabetes. 2021 Mar;13(3):232-242. doi: 10.1111/1753-0407.13108. Epub 2020 Sep 14.
The purpose of this study was to investigate risk factors of in-hospital mortality and vascular complications after coronary artery bypass grafting (CABG), particularly the effect of different glycemic control levels on outcomes in patients with and without previous evidence of diabetes.
A total of 8682 patients with and without previous diabetes undergoing CABG were categorized into strict, moderate, and liberal glucose control groups according to their mean blood glucose control level <7.8 mmol/L, 7.8 to 10.0 mmol/L, and ≥10.0 mmoL/L after in-hospital CABG.
The patients with previous diabetes had higher rates of in-hospital mortality (1.3% vs 0.4%, P < .001) and major complications (7.0% vs 4.8%, P < .001) than those without diabetes. Current diabetes was significantly associated with a higher risk of in-hospital mortality (odds ratio [OR] = 3.14, 95% confidence interval [CI] 1.87-5.27) and major complications (OR = 1.49, 95% CI 1.24-1.80), and smoking and higher low-density lipoprotein cholesterol (LDL-C) levels showed similar results. Among patients with previous diabetes, strict glucose control was significantly associated with an increased risk of in-hospital mortality (OR = 8.32, 95% CI 3.95-17.51) compared with moderate glucose control. Nevertheless, among non-previous diabetic patients with stress hyperglycemia, strict glucose control led to a lower risk of major complications (OR = 0.71, 95% CI 0.52-0.98).
Diabetes status, smoking, and LDL-C levels were modifiable risk factors of both in-hospital mortality and major complications after CABG. Strict glucose control was associated with an increased risk of in-hospital mortality among patients with diabetes, whereas it reduced the risk of major complications among non-previous diabetic patients.
本研究旨在探讨冠状动脉旁路移植术（CABG）后住院期间死亡率和血管并发症的风险因素，特别是不同血糖控制水平对有和无既往糖尿病证据的患者结局的影响。
共纳入 8682 例有和无既往糖尿病的 CABG 患者，根据术后住院期间平均血糖控制水平，将其分为严格、中度和宽松血糖控制组，分别为<7.8mmol/L、7.8 至 10.0mmol/L 和≥10.0mmol/L。
有既往糖尿病的患者住院期间死亡率（1.3%比 0.4%，P<0.001）和主要并发症发生率（7.0%比 4.8%，P<0.001）均高于无糖尿病的患者。当前糖尿病与住院期间死亡率（优势比[OR] = 3.14，95%置信区间[CI] 1.87-5.27）和主要并发症（OR = 1.49，95% CI 1.24-1.80）风险显著相关，而吸烟和较高的低密度脂蛋白胆固醇（LDL-C）水平也有类似的结果。在有既往糖尿病的患者中，与中度血糖控制相比，严格血糖控制与住院期间死亡率增加显著相关（OR = 8.32，95% CI 3.95-17.51）。然而，在应激性高血糖的非既往糖尿病患者中，严格血糖控制可降低主要并发症的风险（OR = 0.71，95% CI 0.52-0.98）。
糖尿病状态、吸烟和 LDL-C 水平是 CABG 后住院期间死亡率和主要并发症的可改变风险因素。严格血糖控制与糖尿病患者的住院期间死亡率增加相关，而在非既往糖尿病患者中，它降低了主要并发症的风险。
