Glycemic control and risk factors for in-hospital mortality and vascular complications after coronary artery bypass grafting in patients with and without preexisting diabetes

J Diabetes. 2021 Mar;13(3):232-242. doi: 10.1111/1753-0407.13108. Epub 2020 Sep 14.

Abstract
in English, Chinese

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

目的: 探讨冠状动脉旁路移植术患者院内死亡和血管并发症的影响因素, 重点分析不同血糖控制水平对有, 无糖尿病史患者术后并发症的影响。 方法: 8682名接受冠状动脉旁路移植术治疗患者依术后平均血糖控制水平分为严格, 中度和宽松血糖控制三个组。各组平均血糖值依次为<7.8mmol/L, 7.8-10.0mmol/L和≥10.0mmoL/L。 结果: 有糖尿病史的患者院内死亡率及术后主要并发症明显高于无糖尿病史患者(院内死亡率:1.3% vs 0.4%, P <0 .001; 主要并发症:7.0% vs 4.8%, P <0 .001)。糖尿病状态显著增加院内死亡风险(OR:3.14, 95%CI:1.87-5.27)和主要并发症风险(OR = 1.49, 95%CI 1.24-1.80); 吸烟及低密度脂蛋白胆固醇升高亦增加死亡和主要并发症风险。在有糖尿病史患者中, 与中度血糖控制组相比, 严格血糖控制组院内死亡风险明显增加(OR:8.32, 95% CI:3.95-17.51)。与之相反, 在无糖尿病史患者中, 严格血糖控制组的主要并发症风险却明显减少(OR:0.71,95% CI:0.52-0.98)。 结论: 糖尿病, 吸烟和低密度脂蛋白胆固醇升高是冠状动脉旁路移植术后院内死亡和主要并发症的三个可变危险因素。严格血糖控制增加糖尿病手术患者院内死亡风险, 但却可以减少非糖尿病患者术后主要并发症风险。.

Keywords: complications; coronary artery bypass grafting; diabetes; mortality; risk factor; 冠状动脉旁路移植术; 危险因素; 并发症; 死亡率; 糖尿病.

MeSH terms

  • Aged
  • Blood Glucose / metabolism*
  • Coronary Artery Bypass / methods*
  • Coronary Artery Bypass / mortality
  • Coronary Artery Disease / complications*
  • Diabetes Complications / complications*
  • Diabetes Mellitus / blood*
  • Diabetes Mellitus / drug therapy
  • Female
  • Hospital Mortality
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Insulin / therapeutic use
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care / methods
  • Outcome Assessment, Health Care / statistics & numerical data
  • Retrospective Studies
  • Risk Factors

Substances

  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin