Preventing Perioperative Major Adverse Cardiovascular Events in Patients with Diabetes

Jian-zhong Sun , Hai-long Dong , Li-nong Yao , Hong Liu
Department of Anesthesiology, Thomas Jefferson University and Hospitals, Philadelphia, USA, Department of Anesthesiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China, Department of Anesthesiology and CCM, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China, Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, Sacramento, USA
J Anesth Perioper Med 2015; 2(2): 96- 106 . Published on Mar 31, 2015 . doi:10.24015/JAPM.2015.0014
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Aim of review: Diabetes is a chronic and slowly progressing disease that has a tendency todevelop rapidly deteriorating complications such as major adverse cardiovascular events (MACE), especially under the stress of surgery. While clinical strategy to prevent MACE is controversial and uncertain.

Method: We conducted a comprehensive review of current clinical strategies in preventing perioperative MACE, in particularly related to diabetic patients.

Results: The major findings are: 1) Current clinical studies have demonstrated that coronary artery bypass graft (CABG) is still a better therapy than percutaneous coronary intervention (PCI) on the ground of reducing repeat revascularization, myocardial infarction and death for most diabetic patients with left main-stem and multivessel coronary artery disease who require revascularization, however, it remains to be studied whether coronary revascularization before noncardiac surgery can protect diabetic patients from MACE; 2) There is lack of evidence that intensive or "tight" glycemic control perioperatively can reduce MACE, instead, a moderate or less stringent glucose management probably is safer for patients undergoing surgery;3) The recent results of clinical trials on beta-blockers appear to be disappointing in preventing MACE in surgical patients, including diabetic patients. Meanwhile, the perioperative therapy with statins, angiotensin-converting enzyme inhibitors or multifactorial interventions is promising in preventing MACE in diabetic patients.

Summary: Further studies targeted at preventing MACE in diabetic patients undergoing surgery are needed in order to fight this major health problem in perioperative medicine.



Citation: Jian-zhong Sun, Hai-long Dong, Li-nong Yao, Hong Liu. Preventing perioperative major adverse cardiovascular events in patients with diabetes. J Anesth Perioper Med 2015; 2: 96-106. doi: 10.24015/JAPM.2015.0014

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