Higher admission glycaemia independently of diagnosed or unrecognised diabetes mellitus is a risk factor for failed myocardial tissue reperfusion and higher mortality after primary angioplasty.
Higher admission glycaemia independently of diagnosed or unrecognised diabetes mellitus is a risk factor for failed myocardial tissue reperfusion and higher mortality after primary angioplasty.
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DOI：
10.5603/kp.a2017.0258
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发表时间：
2018
影响因子：
3.3
通讯作者：
Łukasz Kalińczuk;K. Zieliński;J. Prȩgowski;J. Przyłuski;M. Karcz;P. Bekta;M. Ciszewski;Z. Dzielińska;A. Witkowski;M. Demkow
中科院分区：
文献类型：
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作者：
Łukasz Kalińczuk;K. Zieliński;J. Prȩgowski;J. Przyłuski;M. Karcz;P. Bekta;M. Ciszewski;Z. Dzielińska;A. Witkowski;M. Demkow
背景与目的st段抬高型心肌梗死（STEMI）入院时高血糖加重再灌注。st段抬高分辨率与心肌组织再灌注平行并预测原发性经皮冠状动脉介入治疗（pPCI）的结果。方法：采用单导联Schröder st段分辨率分析（maxSTE）方法，研究入院时较高的血糖是否会损害STEMI患者pPCI后组织水平的再灌注。结果323例患者（60.4±11.5岁，女性27.8%）中，13.4%的非糖尿病患者和58.2%的已知糖尿病病史患者（17%）入院时血糖为bb0 11.1 mmol/L。25%的患者存在组织再灌注失败，如果符合高危maxSTE标准则可识别。总180天死亡率为6.8% （n = 22）。入院血糖≥8.75 mmol/L是组织再灌注失败的单一危险因素（ROC面积= 0.638，标准误差= 0.038,p 11.1 mmol/L(28%)），入院血糖仍然是组织再灌注失败的独立预测因子（优势比[OR] 1.32, 95% CI 1.03-1.69, p = 0.028）。入院时血糖血症和组织再灌注失败（高风险与低风险maxSTE分类）是180天死亡率的独立预测因子（OR为1.18,95% CI 1.05-1.32, p = 0.004； OR为3.84,95% CI 1.12-13.21, p = 0.033）。结论：接受pPCI治疗的STEMI患者入院时较高的血糖可预测心肌组织再灌注失败和180天死亡率，与既往或急性糖尿病状态无关。
BACKGROUND AND AIM Admission hyperglycaemia worsens reperfusion in ST-segment elevation myocardial infarction (STEMI). ST-segment elevation resolution parallels myocardial tissue reperfusion and predicts the outcome of primary percutaneous coronary intervention (pPCI). METHODS We investigated whether higher glycaemia on admission impairs tissue-level reperfusion after pPCI for STEMI, as-sessed with the single-lead Schröder method of ST-segment resolution analysis (maxSTE). RESULTS Among 323 patients (60.4 ± 11.5 years, 27.8% female), 13.4% of nondiabetic subjects and 58.2% of those with known diabetic history (17%) were admitted with glycaemia > 11.1 mmol/L. Failed tissue reperfusion, recognised if high-risk maxSTE criteria were fulfilled, was present among 25% of patients. The overall 180-day mortality rate was 6.8% (n = 22). Admission glycaemia ≥ 8.75 mmol/L appeared as the single risk factor for failed tissue reperfusion (ROC area = 0.638, standard error = 0.038, p 11.1 mmol/L (28%), admission glycaemia remained an independent predictor of failed tissue reperfusion (odds ratio [OR] 1.32, 95% CI 1.03-1.69, p = 0.028). Admission glycae-mia and failed tissue reperfusion (high- vs. low-risk maxSTE category) were the independent predictors of 180-day mortality (OR 1.18, 95% CI 1.05-1.32, p = 0.004 and OR 3.84, 95% CI 1.12-13.21, p = 0.033, respectively). CONCLUSIONS Higher admission glycaemia in patients treated with pPCI for STEMI predicts failed myocardial tissue reperfusion and 180-day mortality, independently of prior or acute diabetic status.