Glucose levels predict postop myocardial injury, death

  • Punthakee Z & al.
  • Lancet Diabetes Endocrinol
  • 26 Jul 2018

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Preoperative glucose levels can help assess risk for myocardial injury after noncardiac surgery (MINS).

Why this matters

  • MINS is the most common perioperative cardiovascular complication and independently associated with 30-day mortality.

Study design

  • Prospective multicenter study of 11,954 patients aged ≥45 years having noncardiac surgery, 23% with diabetes.
  • Funding: Canadian Institutes of Health Research; other non-Pharma Canadian institutions. 

Key results

  • Within first 3 postoperative days, MINS occurred in 7% overall, including 11% of those with diabetes and 6% without diabetes (OR, 1.98; P<.0001>
  • Within 30 days, death rates were 2% overall, 3% with diabetes, and 2% without diabetes (OR, 1.41; P=.016).  
  • aOR for MINS increased 6% for every 1 mmol/L higher glucose level (1.06; P=.0003), regardless of diabetes status (Pinteraction=.80).
  • Adjusted HR for 30-day mortality increased 8% for every 1 mmol/L higher glucose (1.08; P=.0051), driven by group without diabetes (Pinteraction=.046).
  • For casual glucose concentrations, cutoffs for development of MINS were >7.92 mmol/L with diabetes (OR, 1.47; P=.0096) and >6.86 mmol/L without (1.71; P<.0001>
  • Fasting glucose cutoff for those without diabetes was >6.41 mmol/L (2.71; P<.0001 but no cutoff was found in those with diabetes.>

Limitations

  • Possible unmeasured confounders.
  • Glucose cutoffs derived empirically.
  • Diabetes status was self-reported.

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