Usefulness of preoperative oral glucose tolerance testing for perioperative risk stratification in patients scheduled for elective vascular surgery
| Autor: | Sanne E. Hoeks, Peter G. Noordzij, Don Poldermans, Radosav Vidakovic, David B. Schockman, Martin Dunkelgrun, Olaf Schouten, Frodo Schreiner, Harm H.H. Feringa, Gijs M.J.M. Welten, Eric Boersma, Dustin Goei |
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| Přispěvatelé: | Anesthesiology, Cardiology |
| Rok vydání: | 2008 |
| Předmět: |
Male
medicine.medical_specialty endocrine system diseases Myocardial Ischemia Risk Assessment Impaired glucose tolerance SDG 3 - Good Health and Well-being Internal medicine Diabetes mellitus Preoperative Care Diabetes Mellitus medicine Humans Prospective Studies Renal Insufficiency Risk factor Prospective cohort study Aged Heart Failure business.industry Age Factors nutritional and metabolic diseases Odds ratio Perioperative Glucose Tolerance Test Vascular surgery medicine.disease Confidence interval Multivariate Analysis Cardiology Female Cardiology and Cardiovascular Medicine business Vascular Surgical Procedures |
| Zdroj: | American Journal of Cardiology, 101(4), 526-529. Elsevier Inc. |
| ISSN: | 1879-1913 0002-9149 |
| Popis: | Patients scheduled for major vascular surgery are screened for cardiac risk factors using standardized risk indexes, including diabetes mellitus (DM). Screening. in patients without a history of DM includes fasting glucose measurement. However, an oral glucose tolerance test (OGTT) could significantly improve the detection of DM and impaired glucose tolerance (IGT) and the prediction of perioperative cardiac events. In a prospective study, 404 consecutive patients without signs or histories of IGT or DM were included and subjected to OGTT. The primary study end point was the composite of perioperative myocardial ischemia, assessed by 72-hour Hotter monitoring using ST-segment analysis and troponin release. The primary end point was noted in 21% of the patients. IGT was diagnosed in 104 patients (25.7%), and new-onset DM was detected in 43 patients (10.6%). The OGTT detected 75% of the patients with IGT and 72% of the patients with DM. Preoperative glucose levels significantly predicted the risk for perioperative cardiac ischemia; odds ratios for DM and IGT were, respectively, 3.2 (95% confidence interval 1.3 to 8.1) and 1.4 (95% confidence interval 0.7 to 3.0). In conclusion, the prevalence of undiagnosed IGT and DM is high in vascular patients and is associated with perioperative myocardial ischemia. Therefore, an OGTT should be considered for all patients who undergo elective vascular surgery. (C) 2008 Elsevier Inc. All rights reserved. |
| Databáze: | OpenAIRE |
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