Gustafsson I, Hildebrandt P, Seibaek M, Melchior T, Torp-Pedersen C, Køber L, Kaiser-Nielsen P
Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Copenhagen, Denmark.
Eur Heart J. 2000 Dec;21(23):1937-43. doi: 10.1053/euhj.2000.2244.
The present study was performed to evaluate pre-admission history, presentation, initial treatment and long-term mortality in patients with myocardial infarction and diabetes.
Between 1990 and 1992, 6676 patients with acute myocardial infarction were screened for entry into the Trandolapril Cardiac Evaluation (TRACE) study. In this cohort 719 (11%) of the patients had a history of diabetes. Among the diabetic patients 19% were treated with insulin, 52% with oral hypoglycaemic agents and 29% with diet only. The diabetic patients were slightly older, more likely to be female and had a higher prevalence of known cardiovascular disease. Even though the diabetic patients had the same frequency of ST-segment elevation on the electrocardiogram and the same admission delay, treatment with thrombolysis and aspirin was less frequently prescribed to the diabetic patients than to patients without diabetes. The mortality rate was significantly increased in the diabetic patients, 7-year mortality being 79% in insulin-treated, 73% in tablet-treated and 62% in diet-treated diabetic patients compared with 46% in patients without diabetes. In a multivariate analysis only diabetic patients treated with oral hypoglycaemic agents or with insulin had an increased mortality compared with non-diabetic patients.
Patients with diabetes mellitus and myocardial infarction are treated with thrombolysis to a lesser extent than non-diabetic patients. Diabetic patients treated with oral hypoglycaemic agents or insulin, but not those treated with diet alone, have a significantly increased mortality following acute myocardial infarction compared with non-diabetic patients.
本研究旨在评估心肌梗死合并糖尿病患者的入院前病史、临床表现、初始治疗及长期死亡率。
1990年至1992年间，对6676例急性心肌梗死患者进行筛选，以纳入群多普利心脏评估（TRACE）研究。在该队列中，719例（11%）患者有糖尿病史。在糖尿病患者中，19%接受胰岛素治疗，52%接受口服降糖药治疗，29%仅接受饮食治疗。糖尿病患者年龄稍大，女性比例更高，已知心血管疾病的患病率也更高。尽管糖尿病患者心电图上ST段抬高的频率相同，入院延迟时间也相同，但与非糖尿病患者相比，糖尿病患者接受溶栓和阿司匹林治疗的频率较低。糖尿病患者的死亡率显著增加，胰岛素治疗的糖尿病患者7年死亡率为79%，口服降糖药治疗的为73%，饮食治疗的为62%，而非糖尿病患者为46%。多因素分析显示，与非糖尿病患者相比，仅接受口服降糖药或胰岛素治疗的糖尿病患者死亡率增加。
与非糖尿病患者相比，糖尿病合并心肌梗死患者接受溶栓治疗的比例较低。与非糖尿病患者相比，接受口服降糖药或胰岛素治疗而非仅接受饮食治疗的糖尿病患者急性心肌梗死后死亡率显著增加。
