Clinical impact of admission hyperglycemia on in-hospital mortality in acute myocardial infarction patients
Clinical impact of admission hyperglycemia on in-hospital mortality in acute myocardial infarction patients
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DOI：
10.1016/j.ijcard.2017.01.095
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发表时间：
2017-06-01
影响因子：
3.5
通讯作者：
Chae, Jei Keon
中科院分区：
文献类型：
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作者：
Kim, Eun Jung;Jeong, Myung Ho;Chae, Jei Keon
背景资料：急性高血糖是急性心肌梗死（AMI）患者的常见症状，是影响预后的重要因素之一。然而，高血糖对非糖尿病患者的影响仍存在争议。共12，625名AMI患者（64.0 ± 12.6岁，26.1%女性），2011年11月至2015年12月期间入组韩国急性心肌梗死登记-国立卫生研究院，分为4367例糖尿病患者（65.4 ± 11.6岁，30.4%女性）和8228例非糖尿病患者（63.3 ± 13岁，23.9%女性）。结果：糖尿病患者住院期间死亡率的独立预测因素为高龄、高HbA 1 C、心肌梗死溶栓前（TIMI）血流0、左室射血分数<40%、心源性休克和室性心动过速。在非糖尿病患者中，院内死亡率的独立预测因素为高龄、入院时血糖较高（>= 200 mg/dL）、TIMI前血流0、经皮冠状动脉介入治疗失败、左心室射血分数<40%、心源性休克、支架内血栓形成和Hb降低>= 5 g/dL。糖尿病患者的住院死亡率显著高于非糖尿病患者（5.0% vs. 3.4%，p < 0.001）。然而，与糖尿病患者相比，患有高血糖症的非糖尿病患者具有显著更高的死亡率（17.4%对7.2%，p < 0.001）。合并症，包括心源性休克（p < 0.001），脑出血（p = 0.012），Hb降低= 5 g/dL（p = 0.013），房室传导阻滞（p < 0.001）和室性心动过速（p = 0.007）在非糖尿病伴高血糖患者中高于糖尿病患者。这些发现强调了入院时高血糖对非糖尿病AMI患者住院死亡率的临床意义。(C)2017爱思唯尔B. V.保留所有权利。
Background: Acute hyperglycemia on admission is common in acute myocardial infarction (AMI) patients regardless of diabetic status, and is known as one of prognostic factors. However, the effect of hyperglycemia on non-diabetic patients is still on debate.Methods: A total of 12,625 AMI patients (64.0 +/- 12.6 years, 26.1% female) who were enrolled in Korea Acute Myocardial Infarction Registry-National Institute of Health between November 2011 and December 2015, were classified into 4367 diabetes (65.4 +/- 11.6 years, 30.4% female) and 8228 non-diabetes (63.3 +/- 13 years, 23.9% female). Patients were analyzed for in-hospital clinical outcome according to admission hyperglycemic status.Results: In diabetic patients, independent predictors of in-hospital mortality were old age, high HbA(1)C, pre-Thrombolysis In Myocardial Infarction (TIMI) flow 0, left ventricle ejection fraction < 40%, cardiogenic shock and ventricular tachycardia. In non-diabetic patients, independent predictors of in-hospital mortality were old age, high admission glucose (>= 200 mg/dL), pre TIMI flow 0, failed percutaneous coronary intervention, low left ventricle ejection fraction < 40%, cardiogenic shock, stent thrombosis and decreased Hb >= 5 g/dL. In hospital mortality was significantly higher in diabetic patients compared to non-diabetic patients (5.0% vs. 3.4%, p < 0.001). However, non-diabetic patients with hyperglycemia have significantly higher mortality compared to diabetic patients (17.4% vs. 7.2%, p < 0.001). Comorbidity including cardiogenic shock (p < 0.001), cerebral hemorrhage (p = 0.012), decreased Hb = 5 g/dL (p = 0.013), atrioventricular block (p < 0.001) and ventricular tachycardia (p = 0.007) was higher in non-diabetic with hyperglycemia than in diabetic patients.Conclusions: These findings underscore clinical significance of admission hyperglycemia on in-hospital mortality in non-diabetic AMI patients. (C) 2017 Elsevier B.V. All rights reserved.