Clinical impact of acute hyperglycemia on development of diabetes mellitus in non-diabetic patients with acute myocardial infarction
Clinical impact of acute hyperglycemia on development of diabetes mellitus in non-diabetic patients with acute myocardial infarction
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DOI：
10.1016/j.jjcc.2013.08.012
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发表时间：
2014-03-01
影响因子：
2.5
通讯作者：
Komuro, Issei
中科院分区：
文献类型：
--
作者：
Usami, Masaya;Sakata, Yasuhiko;Komuro, Issei
背景：急性心肌梗死后发生的急性高血糖是一过性糖代谢异常的表现，可反映急性心肌梗死的严重程度，是预后不良的指标。方法与结果：在1998年至2007年大阪急性冠脉功能不全研究中登记的急性心肌梗死患者中，我们调查了1493名入院时糖化血红蛋白A1c(HbA1c)水平为6.5%的患者在5年随访期的住院记录。133例(8.9%)患者入院时血糖水平为200 mg/dl。急性心肌梗死后急性心肌梗死合并急性心肌梗死患者较无急性心肌梗死患者更易发生糖尿病肾病[24.8%比12.0%，调整后危险比(HR)1.776，p=0.021]，尤其是入院时糖化血红蛋白为5.6%的患者。血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂的治疗与急性心肌梗死患者糖尿病肾病的发生率降低相关(调整后的HR为0.397，p=0.031)。结论：急性心肌梗死后非糖尿病患者入院时糖尿病肾病的发生率是一个预测因素。肾素-血管紧张素系统抑制剂与急性心肌梗死后急性心肌梗死患者糖尿病发病率的降低有关。(C)2013年日本心脏病学院。爱思唯尔有限公司出版。保留所有权利。
Background: Acute hyperglycemia (AH) after the onset of acute myocardial infarction (AMI) is a manifestation of transient abnormal glucose metabolism that may reflect AMI severity, and thus be a predictor of poor prognosis. However, it remains unknown whether AH may predict development of de nova diabetes mellitus (dn-DM) in non-diabetic AMI patients.Methods and results: Among AMI patients registered in the Osaka Acute Coronary Insufficiency Study between 1998 and 2007, we investigated hospital records of 1493 patients who had an admission glycated hemoglobin A1c (HbA1c) level of = 6.5% during the 5-year follow-up period. AH, defined as an admission serum glucose level of >= 200mg/dl, was observed in 133 (8.9%) patients. dn-DM development was more frequent in post-AMI patients with AH than those without [24.8% vs 12.0%, adjusted hazard ratio (HR) 1.776, p = 0.021], particularly among patients with an HbA1c of < 5.6% on admission. Treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a reduced incidence of dn-DM in patients with AH (adjusted HR 0.397, p = 0.031).Conclusion: Admission AH was a predictor of dn-DM in non-diabetic post-AMI patients. Renin-angiotensin system inhibitors were associated with reduced incidence of dn-DM in post-AMI patients with AH. (c) 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.