The impact of diabetes on survival among patients with first myocardial infarction
The impact of diabetes on survival among patients with first myocardial infarction
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DOI：
10.2337/diacare.20.5.704
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发表时间：
1997-05-01
期刊：
影响因子：
16.2
通讯作者：
Heller, RF
中科院分区：
文献类型：
--
作者：
Chun, BY;Dobson, AJ;Heller, RF
目的：本文的目的是估计糖尿病对首次急性心肌梗死患者生存的影响，使用来自澳大利亚新南威尔士州纽卡斯尔的世界卫生组织（WHO）心血管疾病监测趋势和决定因素（MONICA）项目的数据。研究设计和方法-世卫组织MONICA项目是一个以社区为基础的监测系统，监测冠心病的发病率和死亡率。所有疑似冠状动脉事件的患者在出现症状后观察28天。结果：5322例无缺血性心脏病史的急性心肌梗死患者（3643例男性，1679例女性）中，333例男性（9%）和224例女性（13%）有糖尿病史。糖尿病妇女经年龄调整后的28天病死率（25%）显著高于无糖尿病妇女（16%）；相对危险度1.56 （95% CI: 1.19-2.04）。男性的差异也很显著（25%患有糖尿病，20%没有糖尿病）；相对危险度1.25 （95% CI: 1.02-1.53）。非糖尿病男性和女性的病死率随年龄的增长而显著增加，但糖尿病患者的系统年龄效应不那么明显。在研究期间，非糖尿病患者的病死率显著下降，但糖尿病患者的病死率没有下降。结论：考虑到糖尿病患者较差的危险因素后，其死亡风险仍然增加；即使他们活着到达医院，糖尿病患者存活的可能性也比非糖尿病患者低。糖尿病对女性生存的相对影响大于男性。
OBJECTIVE - The purpose of this paper is to estimate the impact of diabetes on survival among patients with first acute myocardial infarction, using data from the World Health Organization (WHO) Monitoring Trends and Determinants of Cardiovascular Disease (MONICA) Project in Newcastle, New South Wales, Australia.RESEARCH DESIGN AND METHODS - The WHO MONICA Project is a community-based surveillance system that monitors coronary heart disease morbidity and mortality. All patients with suspected coronary events were observed for 28 days after the onset of symptoms.RESULTS - Of 5,322 patients with acute myocardial infarction and no previous history of ischemic heart disease (3,643 men and 1,679 women), 333 men (9%) and 224 women (13%) had a history of diabetes. The age-adjusted 28-day case fatality for women with diabetes (25%) was significantly higher than for women without diabetes (16%); relative risk 1.56 (95% CI: 1.19-2.04). The difference for men was also significant (25% with diabetes and 20% without diabetes); relative risk 1.25 (95% CI: 1.02-1.53). Age-specific case fatality increased significantly with age in both men and women without diabetes, but systematic age effects were not so apparent in patients with diabetes. Case fatality significantly decreased over the study period in patients without diabetes, but not among the diabetic patients.CONCLUSIONS - The increased risk of death in the diabetic patients remained after accounting for their poorer risk factor profiles; even if they reached the hospital alive, diabetic patients were also less likely to survive than nondiabetic patients. The relative impact of diabetes on survival is greater in women than in men.