Impact of Diabetes Mellitus on Rehospitalization for Heart Failure Among Survivors of Acute Myocardial Infarction in the Percutaneous Coronary Intervention Era
Impact of Diabetes Mellitus on Rehospitalization for Heart Failure Among Survivors of Acute Myocardial Infarction in the Percutaneous Coronary Intervention Era
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DOI：
10.1253/circj.cj-08-0579
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发表时间：
2009-04-01
影响因子：
3.3
通讯作者：
Sato, Hiroshi
中科院分区：
文献类型：
--
作者：
Nakatani, Daisaku;Sakata, Yasuhiko;Sato, Hiroshi
背景资料：关于糖尿病（DM）对急性心肌梗死（AMI）幸存者在经皮冠状动脉介入治疗（PCI）时代心力衰竭（HF）的临床影响的数据很少。方法和结果：本研究组包括4，035名在症状发作后24小时内接受PCI的幸存者。多因素分析显示，糖尿病是心衰再住院的独立预测因素（风险比（HR）1.576，P=0.010）。左心室舒张期内径（LVDd = 51 mm）不增大的DM患者因HF再次住院的风险相似（HR 1.020，P=0.959）。在糖尿病组中，出院前血红蛋白A（1c）水平在因HF再次住院和未再次住院的患者之间相似（7.5 ± 1.9% vs 7.4 ± 1.6%，P=0.455），而高敏C反应蛋白（hs-CRP）在因HF再住院的患者中高于未再住院的患者（1.80 +/- 3.63 vs 0.75 +/- 2.03 mg/dl，P=0.001）结论：在PCI时代，DM是AMI后HF再住院的独立预测因子。无左室重构的糖尿病患者应作为HE的高危人群。检测hs-CRP水平对预测糖尿病患者AMI后因HF再住院有一定意义。(Circ J 2009; 73：662-666）
Background: There is little data regarding the clinical impact of diabetes mellitus (DM) on heart failure (HF) among survivors of acute myocardial infarction (AMI) in the percutaneous coronary intervention (PCI) era.Methods and Results: The present study group comprised 4,035 survivors who underwent PCI within 24h of the onset of symptoms. DM was an independent predictor of rehospitalization for HF by multivariate analysis (hazard ratio (HR) 1.576, P=0.010). The risk of rehospitalization for HF was similar between patients with DM who did not have an enlarged left ventricular diastolic diameter (LVDd = 51 mm) (HR 1.020, P=0.959). In the DM group, the hemoglobin A(1c) level before discharge was similar between patients with and without rehospitalization for HF (7.5 +/- 1.9% vs 7.4 +/- 1.6%, P=0.455), whereas high-sensitiviry C-reactive protein (hs-CRP) was higher in patients with than without rehospitalization for HF (1.80 +/- 3.63 vs 0.75 +/- 2.03 mg/dl, P=0.001).Conclusions: DM is an independent predictor of rehospitalization for HF after AMI in the PCI era. Diabetic patients without left ventricular remodeling a should be treated as a high-risk group for HE Measurement of hs-CRP level may be useful for predicting rehospitalization because of HF in diabetic patients after AMI. (Circ J 2009; 73: 662-666)