Hyperglycaemia, adverse outcomes and impact of intravenous insulin therapy in patients presenting with acute ST-elevation myocardial infarction in a socioeconomically disadvantaged urban setting: The Montefiore STEMI Registry.
Hyperglycaemia, adverse outcomes and impact of intravenous insulin therapy in patients presenting with acute ST-elevation myocardial infarction in a socioeconomically disadvantaged urban setting: The Montefiore STEMI Registry.
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在社会经济弱势的城市环境中，静脉注射胰岛素治疗对急性 ST 段抬高型心肌梗死患者的高血糖、不良后果和影响：Montefiore STEMI 登记处。
DOI：
10.1002/edm2.89
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发表时间：
2020
影响因子：
--
通讯作者：
Kizer,JorgeR
中科院分区：
文献类型：
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作者：
Shitole,SanyogG;Srinivas,Vankeepuram;Berkowitz,JuliaL;Shah,Tina;Park,MichaelJ;Herzig,Samuel;Christian,Anne;Patel,Neeral;Xue,Xiaonan;Scheuer,James;Kizer,JorgeR
背景：高血糖常发生于ST段抬高型心肌梗死（STEMI），且预后不良，持续胰岛素输注治疗（CIIT）可能对其有益。信息是有限的急性ST段抬高型心肌梗死影响城市少数民族人群，或如何CIIT票价在这样的真实的世界settings.Methods和resultsWe组装了一个急性ST段抬高型心肌梗死登记在内城的卫生系统，专注于患者的初始血糖≥180 mg/dL，以确定CIIT与常规护理的影响。通过与电子记录的链接添加临床和结局数据。使用倾向评分（PS）进行治疗的逆概率加权，以比较CIIT与无CIIT。纳入的1067例患者大多为西班牙裔或非裔美国人; 356例血糖≥180 mg/dL。这种明显的高血糖症与女性、少数民族和较低的社会经济评分有关，并与死亡和死亡或CVD再入院增加有关。CIIT优先用于显著高血糖患者，与院内低血糖相关（21% vs 11%，P = 0.019），PS加权后，院内（RR 3.23，95% CI 0.94，11.06）和1年（RR 2.26，95% CI 1.02，4.98）死亡率增加。在30天或整个随访期间的死亡率，或死亡和再入院在任何时间点，没有显着差异，观察到的。CIIT符合选择性使用，并与低血糖相关，以及特定时间点的死亡率增加。鉴于代谢疾病的负担，特别是在少数民族中，评估CIIT的益处是一项特权，需要在大规模随机试验中进行评估。
BackgroundHyperglycaemia occurs frequently in ST‐elevation myocardial infarction (STEMI) and is associated with poor outcomes, for which continuous insulin infusion therapy (CIIT) may be beneficial. Information is limited regarding hyperglycaemia in acute STEMI affecting urban minority populations, or how CIIT fares in such real‐world settings.Methods and resultsWe assembled an acute STEMI registry at an inner‐city health system, focusing on patients with initial blood glucose ≥180 mg/dL to determine the impact of CIIT vs usual care. Clinical and outcomes data were added through linkage to electronic records. Inverse‐probability‐of‐treatment weighting using propensity scores (PS) was used to compare CIIT vs no CIIT. The 1067 patients included were mostly Hispanic or African American; 356 had blood glucose ≥180 mg/dL. Such pronounced hyperglycaemia was related to female sex, minority race‐ethnicity and lower socioeconomic score, and associated with increased death and death or CVD readmission. CIIT was preferentially used in patients with marked hyperglycaemia and was associated with in‐hospital hypoglycaemia (21% vs 11%,P= .019) and, after PS weighting, with increased in‐hospital (RR 3.23, 95% CI 0.94, 11.06) and 1‐year (RR 2.26, 95% CI 1.02, 4.98) mortality. No significant differences were observed for death at 30 days or throughout follow‐up, or death and readmission at any time point.ConclusionsPronounced hyperglycaemia was common and associated with adverse prognosis in this urban population. CIIT met with selective use and was associated with hypoglycaemia, together with increased mortality at specific time points. Given the burden of metabolic disease, particularly among race‐ethnic minorities, assessing the benefits of CIIT is a prerogative that requires evaluation in large‐scale randomized trials.