OUTCOME OF PATIENTS WITH DIABETES-MELLITUS AND ACUTE MYOCARDIAL-INFARCTION TREATED WITH THROMBOLYTIC AGENTS
OUTCOME OF PATIENTS WITH DIABETES-MELLITUS AND ACUTE MYOCARDIAL-INFARCTION TREATED WITH THROMBOLYTIC AGENTS
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DOI：
10.1016/0735-1097(93)90348-5
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发表时间：
1993-03-15
影响因子：
24
通讯作者：
TOPOL, EJ
中科院分区：
文献类型：
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作者：
GRANGER, CB;CALIFF, RM;TOPOL, EJ
目标。本研究旨在评估接受溶栓治疗的糖尿病患者的预后，并确定血管造影特征的差异是否可以解释糖尿病患者观察到的较差的预后。已知糖尿病患者在急性心肌梗死后的预后比非糖尿病患者差。对心肌梗死溶栓成形术（TAMI）试验中148例糖尿病患者和923例非糖尿病患者的临床和血管造影特点进行了分析。糖尿病患者往往年龄较大（中位年龄59岁vs. 56岁），高血压和高脂血症的发生率较高，吸烟的发生率较低。糖尿病患者比非糖尿病患者有更严重的解剖疾病（66%比46%有多血管疾病，p < 0.0001），相似的整体左心室射血分数（49%比51%）和更差的非梗死区心室功能（-0.13比0.32 SD/chord, p = 0.02）。溶栓治疗后90分钟血管造影通畅率在糖尿病患者和非糖尿病患者中相似（90分钟初始通畅率71% vs 70%）。糖尿病患者的住院死亡率几乎是前者的两倍（11%对6%，p < 0.02），肺水肿发生率更高（11%对4%，p = 0.001）。糖尿病妇女的住院死亡率特别高（21%）。未见视网膜出血。虽然糖尿病作为一个未经调整的变量可以预测住院死亡率（p < 0.02）和长期死亡率（p = 0.003），但在调整基线临床和血管造影特征后，糖尿病并没有发现对死亡率有独立的影响。心肌梗死后糖尿病患者的预后比无糖尿病患者差，尽管梗死血管通畅率相似。然而，糖尿病并不是死亡率增加的独立危险因素。这些发现表明，糖尿病本身并不是心肌梗死溶栓治疗后早期预后不良的主要危险因素；相反，继发性影响，如更广泛的冠状动脉疾病，导致了更糟糕的结果。
Objectives. This study was designed to assess outcome in patients with diabetes who received thrombolytic therapy and to determine whether differences in angiographic characteristics may account for the worse outcome observed in diabetic patients.Background. Patients with diabetes are known to have a worse outcome after acute myocardial infarction than that of patients without diabetes.Methods. Clinical and angiographic characteristics of the 148 patients with diabetes and the 923 patients without diabetes in the Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) trials were examined and analyzed.Results. Patients with diabetes tended to be older (median age 59 vs. 56 years) and to have a higher incidence of hypertension and hyperlipidemia and a lower incidence of cigarette smoking. Patients with diabetes had significantly more severe anatomic disease (66% vs. 46% had multivessel disease, p < 0.0001), similar global left ventricular ejection fraction (49% vs. 51%) and worse non-infarct zone ventricular function (-0.13 vs. 0.32 SD/chord, p = 0.02) than that of nondiabetic patients. Angiographic patency rates at 90 min after thrombolytic therapy were similar in patients with and without diabetes (initial 90-min patency 71% vs. 70%). Diabetic patients had nearly twice the in-hospital mortality rate (11% vs. 6%, p < 0.02) and a higher incidence of pulmonary edema (11% vs. 4%, p = 0.001). Diabetic women had an especially high in-hospital mortality rate (21%). No retinal hemorrhages were observed. Although diabetes as an unadjusted variable was predictive of in-hospital (p < 0.02) and long-term (p = 0.003) mortality, after adjustment for baseline clinical and angiographic characteristics, diabetes was not found to have an independent influence on mortality.Conclusions. Patients with diabetes after myocardial infarction have a worse outcome than that of patients without diabetes despite similar rates of infarct vessel patency. However, diabetes was not found to be an independent risk factor for increased mortality. These findings suggest that diabetes itself is not a major risk factor for poor early outcome after thrombolytic therapy for myocardial infarction; rather, the secondary effects such as more extensive coronary artery disease account for the worse outcome.