Prognostic Significance of Silent Myocardial Infarction in Newly Diagnosed Type 2 Diabetes Mellitus United Kingdom Prospective Diabetes Study (UKPDS) 79
Prognostic Significance of Silent Myocardial Infarction in Newly Diagnosed Type 2 Diabetes Mellitus United Kingdom Prospective Diabetes Study (UKPDS) 79
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DOI：
10.1161/circulationaha.112.000908
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发表时间：
2013-03-05
期刊：
影响因子：
37.8
通讯作者：
Holman, Rury R.
中科院分区：
文献类型：
--
作者：
Davis, Timothy M. E.;Coleman, Ruth L.;Holman, Rury R.
背景：我们旨在确定新诊断的2型糖尿病患者无症状心肌梗死（SMI）的患病率及其与未来心肌梗死（MI）和全因死亡率的关系。方法和结果：我们检查了英国前瞻性糖尿病研究（UKPDS）中5102例患者的数据，并使用Cox比例风险回归来检查重度精神分裂症状态的结果。在1967例基线数据完整的患者中，326例（16.6%）在入组时有SMI的心电图证据（明尼苏达州代码1.1或1.2）。与没有重度精神分裂症的人相比，患有重度精神分裂症的人更可能是老年人、女性、久坐不动和不吸烟者。尽管接受了更强化的降压治疗，他们的平均血压还是更高；他们更有可能服用阿司匹林和降脂疗法；他们患微血管疾病的几率也更高。在包括UKPDS风险引擎变量的多变量模型中，重度精神分裂症患者与非重度精神分裂症患者的完全调整后的风险比在致死性精神分裂症中为1.58(95%可信区间，1.22-2.05)，在全因死亡率中为1.31（95%可信区间，1.10-1.56）。首次致死性或非致死性心肌梗死和首次非致死性心肌梗死的风险比均不显著。当这些模型中加入SMI时，净重分类指数没有改善，而综合区分指数显示SMI略微改善了致命MI和全因死亡率的预测。结论：约1 / 6的UKPDS合并新诊断的2型糖尿病患者有重度精神分裂症的证据，重度精神分裂症与致死性精神分裂症和全因死亡风险增加独立相关。然而，SMI的识别并没有实质性地增加当前UKPDS风险引擎的预测变量。
Background-We aimed to determine the prevalence of silent myocardial infarction (SMI) in people with newly diagnosed type 2 diabetes mellitus and its relationships to future myocardial infarction (MI) and all-cause mortality.Methods and Results-We examined data from the 5102 patients in the 30-year UK Prospective Diabetes Study (UKPDS) and used Cox proportional hazards regression to examine outcomes by SMI status. Of 1967 patients with complete baseline data, 326 (16.6%) had ECG evidence of SMI (Minnesota codes 1.1 or 1.2) at enrollment. Those with SMI were more likely to be older, female, sedentary, and nonsmokers compared with those without SMI. Their mean blood pressure was greater despite more intensive antihypertensive treatment; they were more likely to be taking aspirin and lipid-lowering therapy; and they had a greater prevalence of microangiopathy. Fully adjusted hazard ratios for those with versus those without SMI in multivariate models that included UKPDS Risk Engine variables were 1.58 (95% confidence interval, 1.22-2.05) for fatal MI and 1.31 (95% confidence interval, 1.10-1.56) for all-cause mortality. Hazard ratios for first fatal or nonfatal MI and for first nonfatal MI were nonsignificant. The net reclassification index showed no improvement when SMI was added to these models, and the integrated discrimination index showed that SMI marginally improved the prediction of fatal MI and all-cause mortality.Conclusions-About 1 in 6 UKPDS patients with newly diagnosed type 2 diabetes mellitus had evidence of SMI, which was independently associated with an increased risk of fatal MI and all-cause mortality. However, identification of SMI does not add substantively to current UKPDS Risk Engine predictive variables.