Chyun Deborah, Vaccarino Viola, Murillo Jaime, Young Lawrence H, Krumholz Harlan M
Yale University, New Haven, Conn., USA.
Am J Crit Care. 2002 Nov;11(6):504-19.
To examine the association between (1) comorbid conditions related to diabetes mellitus, clinical findings on arrival at the hospital, and characteristics of the myocardial infarction and (2) risk of heart failure, recurrent myocardial infarction, and mortality in the year after myocardial infarction in elderly 30-day survivors of myocardial infarction who had non-insulin- or insulin-treated diabetes.
Medical records for June 1, 1992, through February 28, 1993, of Medicare beneficiaries (n = 1698), 65 years or older, hospitalizedfor acute myocardial infarction in Connecticut were reviewed by trained abstractors.
One year after myocardial infarction, elderly patients with non-insulin- and insulin-treated diabetes mellitus had significantly greater risk for readmission for heart failure and recurrent myocardial infarction than did patients without diabetes mellitus, and risk was greater in patients treated with insulin than in patients not treated with insulin. Diabetes mellitus, comorbid conditions related to diabetes mellitus, clinical findings on arrival, and characteristics of the myocardial infarction, specifically measures of ventricular function, were important predictors of these outcomes. Mortality was greater in patients not treated with insulin than in patients treated with insulin; the increased risk was mostly due to comorbid conditions related to diabetes mellitus and poorer ventricular function.
Risk of heart failure, recurrent myocardial infarction, and mortality is elevated in elderly patients who have non-insulin- or insulin-treated diabetes mellitus. Comorbid conditions related to diabetes mellitus and ventricular function at the time of the index myocardial infarction are important contributors to poorer outcomes in patients with diabetes mellitus.
研究（1）与糖尿病相关的合并症、入院时的临床检查结果及心肌梗死特征之间的关联，以及（2）非胰岛素治疗或胰岛素治疗的糖尿病患者，在心肌梗死30天存活的老年患者中，心肌梗死后一年内发生心力衰竭、复发性心肌梗死及死亡的风险。
由经过培训的摘要撰写人员，回顾了1992年6月1日至1993年2月28日期间，康涅狄格州65岁及以上因急性心肌梗死住院的医疗保险受益人的病历（n = 1698）。
心肌梗死后一年，非胰岛素治疗和胰岛素治疗的糖尿病老年患者因心力衰竭和复发性心肌梗死再次入院的风险，显著高于非糖尿病患者，且胰岛素治疗患者的风险高于未接受胰岛素治疗的患者。糖尿病、与糖尿病相关的合并症、入院时的临床检查结果以及心肌梗死特征，特别是心室功能指标，是这些结局的重要预测因素。未接受胰岛素治疗的患者死亡率高于接受胰岛素治疗的患者；风险增加主要归因于与糖尿病相关的合并症和较差的心室功能。
非胰岛素治疗或胰岛素治疗的糖尿病老年患者发生心力衰竭、复发性心肌梗死及死亡的风险升高。与糖尿病相关的合并症以及首次心肌梗死时的心室功能，是糖尿病患者预后较差的重要因素。
