Prevalence of glucose abnormalities among patients presenting with an acute myocardial infarction.
Prevalence of glucose abnormalities among patients presenting with an acute myocardial infarction.
复制标题
DOI：
10.1016/j.ahj.2014.06.023
复制
发表时间：
2014-10
影响因子：
4.8
通讯作者：
Kosiborod, Mikhail
中科院分区：
文献类型：
--
作者：
Arnold, Suzanne V.;Lipska, Kasia J.;Li, Yan;McGuire, Darren K.;Goyal, Abhinav;Spertus, John A.;Kosiborod, Mikhail
血糖异常的急性心肌梗死（AMI）患者死亡和不良缺血结局的风险增加。在美国，由HbA1c决定的AMI患者中当前葡萄糖异常的患病率尚不清楚。在2005-2008年的24个美国AMI登记中心中，我们使用HbA1c检查了AMI住院患者是否存在血糖异常，并在核心实验室进行了分析。根据美国糖尿病协会指南，患者分为糖尿病（HbA1c≥6.5%）、糖尿病前期（HbA1c 5.7-6.4%）或血糖正常。比较各组之间的基线人口统计学、临床和代谢特征以及长期全因死亡率。2853例AMI患者中，糖尿病患者1083例（38%），其中新诊断196例（18%）。另外还有887例（31%）糖尿病前期患者和883例（31%）葡萄糖代谢正常的患者。代谢异常的患者年龄较大，多为女性，心脏和非心脏合并症的患病率较高，包括多血管疾病和左心室收缩功能障碍。代谢异常增加的患者在AMI发生后的3年内死亡率更高（血糖正常者为8.6%，糖尿病前期为10.6%，新诊断糖尿病为11.3%，已知糖尿病为20.3%,log rank p<0.001）。在一个大型的美国AMI登记中，我们发现近7 / 10的患者患有血糖异常，38%的患者患有糖尿病，另外31%的患者根据HbA1c水平患有糖尿病前期。在入院时没有已知糖尿病诊断的患者中，超过一半的人要么是新诊断的糖尿病，要么是糖尿病前期。逐渐加重的血糖异常严重程度也与长期死亡率的增加有关。这些数据强调AMI住院是筛查血糖异常的关键机会，因此可以在出院前实施适当的干预措施和患者教育工作。
Patients with an acute myocardial infarction (AMI) who have glucose abnormalities are at increased risk for death and adverse ischemic outcomes. The contemporary prevalence of glucose abnormalities among AMI patients in the U.S., as determined by HbA1c, is unknown. Patients hospitalized with AMI in a 24-site U.S. AMI registry from 2005-2008 were examined for the presence of dysglycemia using HbA1c, which was analyzed at a core laboratory. Patients were categorized by American Diabetes Association guidelines as having diabetes (HbA1c ≥6.5%), pre-diabetes (HbA1c 5.7-6.4%), or normoglycemia. Baseline demographic, clinical, and metabolic characteristics, as well as long-term all-cause mortality, were compared among groups. Among 2853 patients with AMI, 1083 (38%) had diabetes, of which 196 (18%) were newly diagnosed. There were an additional 887 patients (31%) with pre-diabetes, and 883 patients (31%) who had normal glucose metabolism. Patients with metabolic abnormalities were older, more frequently female, and had higher prevalence of cardiac and non-cardiac comorbidities, including multivessel disease and left ventricular systolic dysfunction. Patients with increasing metabolic abnormalities had higher mortality over the 3-years after the AMI (8.6% in those with normoglycemia, 10.6% in pre-diabetes, 11.3% in newly diagnosed diabetes, and 20.3% in known diabetes; log rank p<0.001). In a large U.S. AMI registry, we found that nearly 7 in 10 patients had dysglycemia, with 38% having diabetes, and an additional 31% with pre-diabetes based on HbA1c levels. Over half of the patients who did not have a known diagnosis of diabetes at the time of admission had either newly diagnosed diabetes or pre-diabetes. Progressively greater severity of dysglycemia was also associated with incremental increase in long-term mortality. These data highlight the AMI hospitalization as a key opportunity to screen for glucose abnormalities, so that appropriate interventions and patient education efforts can be implemented prior to discharge.
登录
查看更多内容
影响因子：
5.7
作者：
Bartnik, M.;Ryden, L.;Soler-Soler, J.
通讯作者：
Soler-Soler, J.
影响因子：
5.7
作者：
de Mulder, Maarten;Oemrawsingh, Rohit M.;Umans, Victor A.
通讯作者：
Umans, Victor A.
影响因子：
39.3
作者：
Ryden, Lars;Grant, Peter J.;Zamorano, Jose Luis
通讯作者：
Zamorano, Jose Luis
影响因子：
9.3
作者：
Knudsen EC;Seljeflot I;Abdelnoor M;Eritsland J;Mangschau A;Arnesen H;Andersen GO
通讯作者：
Andersen GO
影响因子：
120.7
作者：
Krumholz, Harlan M.;Wang, Yun;Chen, Jersey;Drye, Elizabeth E.;Spertus, John A.;Ross, Joseph S.;Curtis, Jeptha P.;Nallamothu, Brahmajee K.;Lichtman, Judith H.;Havranek, Edward P.;Masoudi, Frederick A.;Radford, Martha J.;Han, Lein F.;Rapp, Michael T.;Straube, Barry M.;Normand, Sharon-Lise T.
通讯作者：
Normand, Sharon-Lise T.