Abstract 3765: Increased Glucose And Glycosylated Hemoglobin Levels In Relation To Cardiac Ischemic Events In Diabetic And Non-diabetic Vascular Surgery Patients
Background: Diabetes is a risk factor in patients undergoing major vascular surgery. This study evaluates whether increased glucose and glycosylated hemoglobin (HbA1c) levels are associated with increased cardiac ischemic events in diabetic and non-diabetic vascular surgery patients.
Methods: Glucose and HbA1c levels were measured in 401 patients prior to major vascular surgery. Increased glucose level (pre-diabetes) was defined as random glucose 5.6 –11.1 mmol/L. Diabetes was defined as the use of glucose lowering medication or random glucose ≥11.1 mmol/L. Perioperative myocardial ischemia was identified by continuous 72-hour 12-lead electrocardiographic monitoring. Troponin T was measured on day 1, 3, 7 and before discharge. Cardiac events (cardiac death or Q-wave infarction) were noted at 30-day and follow-up (mean 2.5 years).
Results: Mean glucose and HbA1c was 6.3 ± 2.3 mmol/L and 6.2 ± 1.3%, respectively. Myocardial ischemia, troponin T release, 30-day and long-term cardiac events occurred in 27%, 22%, 6% and 17% of patients, respectively. Multivariate analysis revealed that patients with respectively increased glucose levels and diabetes were at 2.2- and 2.6-fold increased risk for myocardial ischemia, 3.8- and 3.9-fold for troponin T release, 4.3- and 4.8-fold for 30-day cardiac events and 1.9- and 3.1-fold for long-term cardiac events (Table⇓). Patients with HbA1c values above 7% (n=63, 16%) were at 2.8-fold, 2.1-fold, 5.3-fold and 5.6-fold increased risk for myocardial ischemia, troponin T release, 30-day and long-term cardiac events, respectively (Table⇓).
Conclusion: Increased fasting glucose and elevated HbA1c levels are risk factors for cardiac ischemic events in vascular surgery patients. This finding suggests the need for aggressive glucose management in this setting and supports a vigorous screening strategy for early recognition of diabetes.