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