Key result
Poorly-controlled preoperative blood glucose was associated with a higher incidence of myocardial injury after noncardiac surgery compared to well-controlled glucose (27.6% vs 18.7%; OR 1.29; P<0.001).
Why the study?
Perioperative blood glucose level has shown an association with postoperative outcomes, prompting an evaluation of MINS and 30-day mortality according to preoperative glucose and HbA1c levels.
Does poorly-controlled preoperative blood glucose or HbA1c increase the risk of myocardial injury and 30-day mortality in patients undergoing noncardiac surgery?
Cohort (n=12,304)
Does poorly-controlled preoperative blood glucose or HbA1c increase the risk of myocardial injury and 30-day mortality in patients undergoing noncardiac surgery?
Preoperative hyperglycemia, but not HbA1c, is associated with an increased risk of myocardial injury and 30-day mortality after noncardiac surgery, suggesting immediate glucose control may be more critical than long-term control.
Answers are grounded in this paper and cite their sources.
Preoperative hyperglycemia may merit attention before noncardiac surgery; leaves open whether targeted intervention reduces MINS.
BackgroundPerioperative blood glucose level has shown an association with postoperative outcomes. We compared the incidences of myocardial injury after noncardiac surgery (MINS) and 30-day mortality according to preoperative blood glucose and hemoglobin A1c (HbA1c) level.methodsThe patients were divided according to blood glucose level within one day before surgery. The poorly-controlled group was defined with fasting glucose > 140 mg/dl or random glucose > 180 mg/dl. Additionally, we compared the outcomes according to HbA1c > 6.5% among patients with available HbA1c within 3 months before surgery. The primary outcome was MINS, and 30-day mortality was also compared.ResultsA total of 12,304 patients was enrolled and divided into 8,324 (67.7%) in the well-controlled group and 3,980 (32.3%) in the poorly-controlled group. After adjustment with inverse probability of weighting, the poorly-controlled group exhibited significantly higher incidences of MINS and 30-day mortality (18.7% vs. 27.6%; odds ratio [OR], 1.29; 95% confidence interval [CI], 1.18–1.42; P < 0.001 and 2.0% vs. 5.1%; hazard ratio [HR], 2.00; 95% CI, 1.61–2.49; P < 0.001, respectively). In contrast to blood glucose, HbA1c was not associated with MINS or 30-day mortality.ConclusionPreoperative hyperglycemia was associated with MINS and 30-day mortality, while HbA1c was not. Immediate glucose control may be more crucial than long-term glucose control in patients undergoing noncardiac surgery. Trial registration: KCT0004244
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Park et al. (2020) conducted a cohort in Patients undergoing noncardiac surgery (n=12,304). Poorly-controlled preoperative blood glucose (fasting > 140 mg/dl or random > 180 mg/dl) vs. Well-controlled preoperative blood glucose was evaluated on Myocardial injury after noncardiac surgery (MINS) (OR 1.29, 95% CI 1.18-1.42, p=< 0.001). Poorly-controlled preoperative blood glucose was associated with a higher incidence of myocardial injury after noncardiac surgery compared to well-controlled glucose (27.6% vs 18.7%; OR 1.29; P<0.001).
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