You Hongzhao, Hou Xiaopei, Zhang Heng, Li Xiaojue, Feng Xinxing, Qian Xin, Shi Na, Guo Rong, Wang Xuan, Sun Hansong, Feng Wei, Li Guangwei, Zheng Zhe, Chen Yanyan
Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China.
Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Diabetol Metab Syndr. 2023 Feb 14;15(1):20. doi: 10.1186/s13098-023-00984-4.
The optimal glycemic control level in diabetic patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (On-Pump) remains unclear. Therefore, this study aimed to investigate the effect of different blood glucose control levels and glucose fluctuations on in-hospital adverse outcomes in diabetic patients undergoing on-pump CABG.
A total of 3918 patients with diabetes undergoing CABG were reviewed in this study. A total of 1638 patients were eligible for inclusion and were categorized into strict, moderate and liberal glucose control groups based on post-operative mean blood glucose control levels of < 7.8 mmol/L, from 7.8 to 9.9 mmol/L and ≥ 10.0 mmoL/L, respectively. The primary endpoint was defined as a composite endpoint including in-hospital all-cause mortality and major cardiovascular complications. The secondary endpoint was defined as major cardiovascular complications including acute myocardial infarction, strokes and acute kidney injuries. To determine the associations between blood glucose fluctuations and adverse outcomes, patients with different glycemic control levels were further divided into subgroups according to whether the largest amplitude of glycemic excursion (LAGE) was ≥ 4.4 mmol/L or not.
A total of 126 (7.7%) patients had a composite endpoint. Compared with moderate control, strict glucose control was associated with an increased risk of the primary endpoint (adjusted OR = 2.22, 95% CI 1.18-4.15, p = 0.01) and the secondary endpoint (adjusted OR = 1.95, 95% CI 1.01-3.77, p = 0.049). Furthermore, LAGE ≥ 4.4 mmol/L was significantly associated with the primary endpoint (adjusted OR = 1.67, 95% CI 1.12-2.50, p = 0.01) and the secondary endpoint (adjusted OR = 1.75, 95% CI 1.17-2.62, p = 0.01),respectively. Patients with LAGE ≥ 4.4 mmol/L had significantly higher rates of the composite endpoint and major vascular complications in both the strict-control (the primary endpoint, 66.7% vs 12.4%, p = 0.034, the secondary endpoint, 66.7% vs 10.3%, p = 0.03) and moderate-control groups (the primary endpoint, 10.2% vs 6.0%, p = 0.03, the secondary endpoint, 10.2% vs 5.8%, p = 0.02).
After On-Pump CABG patients with diabetes, strict glucose control (< 7.8 mmol/L) and relatively large glucose fluctuations (LAGE ≥ 4.4 mmol/L) were independently associated with in-hospital adverse outcomes.
接受体外循环冠状动脉搭桥术（CABG）的糖尿病患者的最佳血糖控制水平仍不明确。因此，本研究旨在探讨不同血糖控制水平和血糖波动对接受体外循环CABG的糖尿病患者院内不良结局的影响。
本研究回顾了3918例接受CABG的糖尿病患者。共有1638例患者符合纳入标准，并根据术后平均血糖控制水平分别<7.8 mmol/L、7.8至9.9 mmol/L和≥10.0 mmol/L分为严格、适度和宽松血糖控制组。主要终点定义为包括院内全因死亡率和主要心血管并发症的复合终点。次要终点定义为包括急性心肌梗死、中风和急性肾损伤的主要心血管并发症。为了确定血糖波动与不良结局之间的关联，根据血糖波动最大幅度（LAGE）是否≥4.4 mmol/L，将不同血糖控制水平的患者进一步分为亚组。
共有126例（7.7%）患者出现复合终点。与适度控制相比，严格血糖控制与主要终点（调整后的OR = 2.22，95% CI 1.18 - 4.15，p = 0.01）和次要终点（调整后的OR = 1.95，95% CI 1.01 - 3.77，p = 0.049）风险增加相关。此外，LAGE≥4.4 mmol/L分别与主要终点（调整后的OR = 1.67，95% CI 1.12 - 2.50，p = 0.01）和次要终点（调整后的OR = 1.75，95% CI 1.17 - 2.62，p = 0.01）显著相关。LAGE≥4.4 mmol/L的患者在严格控制组（主要终点，66.7% 对12.4%，p = 0.034，次要终点，66.7% 对10.3%，p = 0.03）和适度控制组（主要终点，10.2% 对6.0%，p = 0.03，次要终点，10.2% 对5.8%，p = 0.02）中复合终点和主要血管并发症的发生率均显著更高。
糖尿病患者在体外循环CABG术后，严格血糖控制（<7.8 mmol/L）和相对较大的血糖波动（LAGE≥4.4 mmol/L）与院内不良结局独立相关。
