Abstract

Background Myocardial injury after non-cardiac surgery (MINS) is the most common perioperative cardiovascular complication and is independently associated with 30-day mortality. We aimed to assess the association between preoperative glucose concentration and postoperative MINS and mortality. Methods The VISION study is a prospective cohort study done at 12 centres in eight countries. Patients aged 45 years or older who required at least one overnight hospital admission for non-cardiac surgery were enrolled from Aug 6, 2007, to Jan 11, 2011. In the GlucoVISION analysis, we assessed the relations between preoperative casual or fasting glucose concentration and MINS within 3 days after surgery using logistic regression, and 30-day mortality using Cox proportional regression, in people with and without diabetes. Findings 11954 patients were included in this analysis, of whom 2809 (23%) had diabetes. Within the first three postoperative days, MINS occurred in 813 (7%) patients. 249 (2%) patients died by day 30. More patients with diabetes had MINS (odds ratio [OR] 1.98 [95% CI 1.70-2.30]; p0.0001), and died (OR 1.41 [1.08-1.86]; p=0.016) than did patients without diabetes. Casual glucose concentrations were associated with MINS in all patients (adjusted OR 1.06 [1.04-1.09] per 1 mmol/L increment in glucose; p=0.0003), and with death in patients without diabetes (adjusted hazard ratio [HR] 1.13 [95% CI 1.05-1.23] per mmol/L; p=0.002). We noted a progressive relation between unadjusted fasting glucose concentration and both MINS (OR 1.14 [1.08-1.20] per mmol/L; p0.0001), driven by the effect in the subgroup without previous diabetes (p(interaction)=0.025), and 30-day mortality (HR 1.10 [1.02-1.19] per mmol/L; p=0.013). For patients without diabetes, casual glucose of more than 6.86 mmol/L and fasting glucose of more than 6.41 mmol/L predicted MINS (OR 1.71 [1.36-2.15]; p0.0001, and OR 2.71 [1.85-3.98]; p0.0001, respectively). For patients with diabetes, only casual glucose concentration more than 7.92 mmol/L predicted MINS (OR 1.47 [1.10-1.96]; p=0.0096). Interpretation Preoperative glucose concentration, particularly casual glucose concentration, predicts risk for postoperative cardiovascular outcomes, especially in patients without diabetes. Copyright (c) 2018 Elsevier Ltd. All rights reserved.