Comparison of clinical outcomes and left ventricular remodeling after ST-elevation myocardial infarction between patients with and without diabetes mellitus.
Comparison of clinical outcomes and left ventricular remodeling after ST-elevation myocardial infarction between patients with and without diabetes mellitus.
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DOI：
10.1007/s00380-021-01827-w
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发表时间：
2021-10
影响因子：
1.5
通讯作者：
Fujita H
中科院分区：
文献类型：
--
作者：
Akashi N;Tsukui T;Yamamoto K;Seguchi M;Taniguchi Y;Sakakura K;Wada H;Momomura SI;Fujita H
ST段抬高心肌梗死(STEMI)后的左心室重构(LVR)通常被认为是一种适应性但折衷的现象，尤其是在糖尿病(DM)患者中。然而，在现代再灌注治疗的时代，左心室再狭窄的程度是否与伴或不伴糖尿病的预后不良相关尚不清楚。这是一项单中心回溯性观察性研究。纳入2016年1月至2019年3月间确诊为ST段抬高心肌梗死的患者，分别于基线(入院时)和中期(入院后6~11个月)进行超声心动图检查，分为糖尿病组(n = 98)和非糖尿病组(n = )145例。主要结果是主要不良心血管事件(MACEs)，包括全因死亡、心力衰竭(HF)住院和非致命性心肌梗死。中位随访时间为621天(四分位数范围：304-963天)。与非DM组相比，DM组的急性心肌梗死发生率(P = 0.020)和心力衰竭住院率(P = 0.037)均显著增加(P<0.05)。多因素COX回归分析显示，在控制已知的临床危险因素后，糖尿病患者发生急性心肌梗死的危险比[HR]2.79，95%可信区间[CI]1.2 0~6.47，P = 0.017；心力衰竭住院时间[HR 3.62，95%CI 1.19~11.02，P = 0.023]。左心室阻力与急性心肌梗死(HR2.44，95%CI1.03~5.78，P = 0.044)和心衰住院(HR3.76，95%CI1.15~12.32，P = 0.029)显著相关。DM合并LVR患者的临床预后较差，包括MACES和HF住院，提示DM患者STEMI后最大限度减少LVR尤为关键。
Left ventricular remodeling (LVR) after ST-elevation myocardial infarction (STEMI) is generally thought to be an adaptive but compromising phenomenon particularly in patients with diabetes mellitus (DM). However, whether the extent of LVR is associated with poor prognostic outcome with or without DM after STEMI in the modern era of reperfusion therapy has not been elucidated. This was a single-center retrospective observational study. Altogether, 243 patients who were diagnosed as having STEMI between January 2016 and March 2019, and examined with echocardiography at baseline (at the time of index admission) and mid-term (from 6 to 11 months after index admission) follow-up were included and divided into the DM (n = 98) and non-DM groups (n = 145). The primary outcome was major adverse cardiovascular events (MACEs) defined as the composite of all-cause death, heart failure (HF) hospitalization, and non-fatal myocardial infarction. The median follow-up duration was 621 days (interquartile range: 304–963 days). The DM group was significantly increased the rate of MACEs (P = 0.020) and HF hospitalization (P = 0.037) compared with the non-DM group, despite of less LVR. Multivariate Cox regression analyses revealed that the patients with DM after STEMI were significantly associated with MACEs (Hazard ratio [HR] 2.79, 95% confidence interval [CI] 1.20–6.47, P = 0.017) and HF hospitalization (HR 3.62, 95% CI 1.19–11.02, P = 0.023) after controlling known clinical risk factors. LVR were also significantly associated with MACEs (HR 2.44, 95% CI 1.03–5.78, P = 0.044) and HF hospitalization (HR 3.76, 95% CI 1.15–12.32, P = 0.029). The patients with both DM and LVR had worse clinical outcomes including MACEs and HF hospitalization, suggesting that it is particularly critical to minimize LVR after STEMI in patients with DM.
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影响因子：
18.2
作者：
Hoebers, Loes P.;Vis, Marije M.;Henriques, Jose P. S.
通讯作者：
Henriques, Jose P. S.
影响因子：
6.2
作者：
Lang, Roberto M.;Badano, Luigi P.;Voigt, Jens-Uwe
通讯作者：
Voigt, Jens-Uwe
影响因子：
4.8
作者：
Giannuzzi, P;Temporelli, PL;Nicolosi, GL
通讯作者：
Nicolosi, GL
影响因子：
39.3
作者：
Maack C;Lehrke M;Backs J;Heinzel FR;Hulot JS;Marx N;Paulus WJ;Rossignol P;Taegtmeyer H;Bauersachs J;Bayes-Genis A;Brutsaert D;Bugger H;Clarke K;Cosentino F;De Keulenaer G;Dei Cas A;González A;Huelsmann M;Iaccarino G;Lunde IG;Lyon AR;Pollesello P;Rena G;Riksen NP;Rosano G;Staels B;van Laake LW;Wanner C;Farmakis D;Filippatos G;Ruschitzka F;Seferovic P;de Boer RA;Heymans S
通讯作者：
Heymans S
影响因子：
24
作者：
Galderisi, Maurizio
通讯作者：
Galderisi, Maurizio