糖尿病对 48 小时内接受冠状动脉搭桥手术的急性心肌梗死患者的影响。

IF 2.2 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
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引用次数: 0

摘要

背景:患有冠状动脉疾病的糖尿病患者可从选择性冠状动脉旁路移植手术(CABG)中获益。目前尚不清楚这一优点是否适用于接受手术的急性心肌梗死(AMI)患者:方法:2001 年至 2019 年期间,共有 1,427 名患者在确诊为 AMI 后 48 小时内在本机构接受了 CABG 手术。在这些患者中,206人(14.4%)患有胰岛素依赖型糖尿病(IDDM),148人(10.4%)患有非胰岛素依赖型糖尿病(NIDDM)。研究人员进行了回顾性数据分析:结果:非胰岛素依赖型糖尿病患者围手术期风险最高,EuroScore II为11.6(±10.3)分,而非糖尿病患者为7.8(±8.0)分,IDDM患者为8.4(±7.8)分(p结论:非胰岛素依赖型糖尿病患者在确诊急性心肌梗死后 48 小时内接受 CABG 手术的短期和长期并发症风险都会增加。因此,应该对这一特殊群体在这种情况下接受 CABG 的预期风险和益处进行仔细评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of Diabetes in Patients With Acute Myocardial Infarction Undergoing Coronary Artery Bypass Surgery Within 48 Hours

Background

Diabetic patients with coronary artery disease may benefit from elective coronary artery bypass graft (CABG) surgery. It is unknown whether this merit is transferable to patients with acute myocardial infarction (AMI) undergoing surgery.

Method

A total of 1,427 patients underwent CABG within 48 hours of being diagnosed with AMI at the current institution between 2001 and 2019. Of these patients, 206 (14.4%) had insulin-dependent diabetes mellitus (IDDM) and 148 (10.4%) had non-insulin dependent diabetes mellitus (NIDDM). Retrospective data analysis was performed.

Results

Patients with NIDDM showed the highest perioperative risk profile, with a EuroScore II of 11.6 (±10.3) compared with 7.8 (±8.0) in non-diabetic patients and 8.4 (±7.8) in patients with IDDM (p<0.001). Sub-analysis demonstrated a higher proportion of non-ST-elevation myocardial infarction patients in the NIDDM cohort compared with the IDDM cohort (70.9% vs 56.8%; p=0.005). Postoperatively, NIDDM patients had more sepsis (p<0.01) and longer ventilation times (p<0.001) compared with non-DM and IDDM patients (p<0.01). Wound healing complications were rare, but almost twice as high in NIDDM patients compared with non-DM and IDDM patients (4.7% vs 0.9% vs 2.4%, respectively). The 30-day mortality was highest in the NIDDM cohort (18.3% vs 11.3% vs 7.8%; p=0.012). Analysis of survival for up to 15 years revealed a significantly reduced survival of diabetic patients compared with non-diabetic patients, with lowest survival rates in NIDDM patients (p<0.001).

Conclusions

Non-insulin dependent diabetes mellitus patients undergoing CABG within 48 hours of being diagnosed with AMI are at increased risk of short-term and long-term complications. Therefore, this particular group should undergo a careful evaluation concerning the expected risks and benefits of CABG in this setting.

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来源期刊
Heart, Lung and Circulation
Heart, Lung and Circulation CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
4.50
自引率
3.80%
发文量
912
审稿时长
11.9 weeks
期刊介绍: Heart, Lung and Circulation publishes articles integrating clinical and research activities in the fields of basic cardiovascular science, clinical cardiology and cardiac surgery, with a focus on emerging issues in cardiovascular disease. The journal promotes multidisciplinary dialogue between cardiologists, cardiothoracic surgeons, cardio-pulmonary physicians and cardiovascular scientists.
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