Which is worst in patients undergoing primary angioplasty for acute myocardial infarction? Hyperglycaemia? Diabetes mellitus? Or both?
Which is worst in patients undergoing primary angioplasty for acute myocardial infarction? Hyperglycaemia? Diabetes mellitus? Or both?
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DOI：
10.2143/ac.65.4.2053900
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发表时间：
2010-08-01
影响因子：
1.6
通讯作者：
Ilhan, Erkan
中科院分区：
文献类型：
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作者：
Ergelen, Mehmet;Uyarel, Huseyin;Ilhan, Erkan
目的：本研究的目的是评估入院时高血糖和/或糖尿病（DM）对st段抬高型心肌梗死（STEMI）原发性经皮冠状动脉介入治疗（PCI）结果的影响。方法：在2003年10月至2008年3月期间，2482例STEMI患者（平均年龄56.5±11.9岁，男性2064例）接受了首次PCI治疗，回顾性纳入本研究。入院时静脉血糖水平>= 200 mg/dl定义为高血糖。患者分为四组：非糖尿病/非高血糖（NDNH, n = 1806）患者；糖尿病/非高血糖（DNH, n = 271）患者；非糖尿病/高血糖（NDH, n = 64）；糖尿病/高血糖（DH, n = 341）。结果：NDH患者的住院死亡率（12.5%）高于DH（8.5%）、DNH（6.3%）和NDNH（0.9%）患者（P < 0.001）。NDH患者院内死亡、再梗死和靶血管重建术（主要心脏不良事件[MACE]）的复合终点（18.8%）也高于其他患者（DH, 13.8% vs DNH, 10.3% vs NDNH, 3.7%, P < 0.001）。中位随访时间为21个月。DH患者长期心血管死亡的Kaplan-Meier生存图最差（log rank P < 0.001）。在调整潜在的混杂因素后，NDH （OR 3.04, 95% CI 1.06-8.73; P = 0.03）和DH （OR 2.3, 95% CI 1.29-4.09; P = 0.005）仍然是长期心血管死亡率的独立预测因子，但DNH （OR 1.22, 95% CI 0.57-2.6; P = 0.6）状态不是。结论：STEMI患者合并NDH是院内死亡率和MACE的高危人群。长期心血管疾病死亡率的最坏结果发生在DH患者中。
Objective - The objective of this study was to evaluate the effect of admission hyperglycaemia and/or diabetes mellitus (DM) on the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).Methods - 2482 consecutive patients with STEMI (mean age 56.5 +/- 11.9, years, 2064 men) undergoing primary PCI between October 2003 and March 2008 were retrospectively enrolled into the present study. Hyperglycaemia was defined as a venous plasma glucose level >= 200 mg/dl on admission. Patients were classified into four groups: non-diabetic/non-hyperglycaemic (NDNH, n = 1806) patients; diabetic/non-hyperglycaemic (DNH, n = 271) patients; non-diabetic/hyperglycaemic (NDH, n = 64); and diabetic/hyperglycaemic (DH, n = 341).Results - In-hospital mortality was higher in NDH (12.5%) compared to DH (8.5%), DNH (6.3%), and NDNH (0.9%) patients (P < 0.001). The composite end points including death, reinfarction, and target-vessel revascularization (major adverse cardiac events [MACE]) in the hospital were also higher in NDH (18.8%) compared with other patients (DH, 13.8% vs. DNH, 10.3% vs. NDNH, 3.7%, P < 0.001). The median follow-up time was 21 months. The Kaplan-Meier survival plot for long-term cardiovascular death was worst for DH patients (log rank P < 0.001). After adjustment for potentially confounding factors, NDH (OR 3.04, 95% CI 1.06-8.73; P = 0.03), and DH (OR 2.3, 95% CI 1.29-4.09; P = 0.005), but not DNH (OR 1.22, 95% CI 0.57-2.6; P = 0.6) status, remained independent predictors of long-term cardiovascular mortality.Conclusions - STEMI patients with NDH represent the highest risk population for in-hospital mortality, and MACE. The worst outcomes for long-term cardiovascular mortality occur in DH patients.