Relationship between Perioperative Cardiovascular Events and Glycated Hemoglobin in Diabetic Patients Undergoing Noncardiac Surgery

Abstract

This retrospective nested case-control study is aimed at investigating the relationship between HbAlc and perioperative cardiovascular events (PCE) in patients with diabetes who underwent complex or moderately complex noncardiac surgery at the Second Affiliated Hospital of Xinjiang Medical University in 2013-2018. The patients were divided into four groups according to HbA1c ≤7%, 7.1%-7.9%, 8.0%-8.9%, and ≥9%. The occurrence of PCE among the groups was compared using univariable and multivariable analyses. Finally, 318 patients were included. There were 90 cases of PCE among the 318 patients; the occurrence rate of PCE was 28.3%. No death occurred. The occurrence rates of PCE in the $\text{HbA}1\text{c}\ge 8.0\%-8.9\%$ and $\text{HbA}1\text{c}\ge 9.0\%$ groups were 30.8% and 35.4%, respectively ( $P<0.001$ vs. the HbA1c 7.1%-7.9% group). The occurrence rate of PCE in the $\text{HbA}1\text{c}\le 7\%$ group was 25.9% ( $P>0.05$ vs. the HbA1c 7.1%-7.9% group). The multivariable logistic regression analysis showed that the course of diabetes (HbA1c stratification ≤7%, 7.1%-7.9%, 8.0%-8.9%, ≥9%, $\text{OR}=3.672$ , 95% CI: 1.552-8.687), HbA1c ( $\text{OR}=1.895$ , 95% CI: 1.227-4.830), SBP ( $\text{OR}=1.194$ , 95% CI: 1.015-2.023), and microalbuminuria ( $\text{OR}=1.098$ , 95% CI: 1.005-1.023) was independently associated with PCE in diabetic patients. In conclusion, HbA1c levels are related to the incidence of PCE in diabetic patients undergoing complex or moderately complex noncardiac surgery.