Hyperglycemia and risk of ventricular tachycardia among patients hospitalized with acute myocardial infarction.
Hyperglycemia and risk of ventricular tachycardia among patients hospitalized with acute myocardial infarction.
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DOI：
10.1186/s12933-018-0779-8
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发表时间：
2018-10-19
影响因子：
9.3
通讯作者：
Goldberg RJ
中科院分区：
文献类型：
--
作者：
Tran HV;Gore JM;Darling CE;Ash AS;Kiefe CI;Goldberg RJ
我们在本研究中对急性心肌梗死(AMI)住院患者高血糖与室性心动过速(VT)发展的关系知之甚少。这项社区观察性研究的目的是研究急性心肌梗死患者入院时血糖升高与急性住院期间室性心动过速的发生以及室速发生时间之间的关系。我们使用了一项基于人群的研究数据，该研究对2001年至2011年期间在马萨诸塞州中部所有医疗中心住院的AMI患者进行了研究。高血糖定义为入院时的血糖水平 ≥ 140 mg/dl。室性心动过速的发展是由我们训练有素的数据抽象员团队从医生的笔记和心电图发现中确定的。研究人群的平均年龄为70岁，其中58.0%为男性，92.7%为非西班牙裔白人。入院时的平均血糖水平为171.4 mg/dl，中位数为143.0。51.9%的患者在入院时存在高血糖；652名患者(15.8%)发生了室速，其中三分之二发生在入院后48小时内(早期室速)。经多因素调整后，高血糖患者发生室性心动过速的危险性增加(调整后OR = 为1.48，95%CI = 为1.23~1.78)。高血糖的存在与早期(多变量调整OR = 1.39，95%CI = 1.11~1.73)显著相关，但与晚期VT无关。在合并和不合并糖尿病的患者以及合并和不合并ST段抬高的急性心肌梗死患者中也观察到了类似的相关性。应努力密切监测和治疗出现高血糖的患者，特别是入院后早期，以降低他们发生室性心动过速的风险。
Little is known about the association of hyperglycemia with the development of ventricular tachycardia (VT) in patients hospitalized with acute myocardial infarction (AMI) which we examined in the present study. The objectives of this community-wide observational study were to examine the relation between elevated serum glucose levels at the time of hospital admission for AMI and occurrence of VT, and time of occurrence of VT, during the patient’s acute hospitalization. We used data from a population-based study of patients hospitalized with AMI at all central Massachusetts medical centers between 2001 and 2011. Hyperglycemia was defined as a serum glucose level ≥ 140 mg/dl at the time of hospital admission. The development of VT was identified from physicians notes and electrocardiographic findings by our trained team of data abstractors. The average age of the study population was 70 years, 58.0% were men, and 92.7% were non-Hispanic whites. The mean and median serum glucose levels at the time of hospital admission were 171.4 mg/dl and 143.0, respectively. Hyperglycemia was present in 51.9% of patients at the time of hospital admission; VT occurred in 652 patients (15.8%), and two-thirds of these episodes occurred during the first 48 h after hospital admission (early VT). After multivariable adjustment, patients with hyperglycemia were at increased risk for developing VT (adjusted OR = 1.48, 95% CI = 1.23–1.78). The presence of hyperglycemia was significantly associated with early (multivariable adjusted OR = 1.39, 95% CI = 1.11–1.73) but not with late VT. Similar associations were observed in patients with and without diabetes and in patients with and without ST-segment elevation AMI. Efforts should be made to closely monitor and treat patients who develop hyperglycemia, especially early after hospital admission, to reduce their risk of VT.
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