Ishihara Masaharu, Inoue Ichiro, Kawagoe Takuji, Shimatani Yuji, Kurisu Satoshi, Nishioka Kenji, Umemura Takashi, Nakamura Shuji, Yoshida Masashi
Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan.
Am Heart J. 2003 Oct;146(4):674-8. doi: 10.1016/S0002-8703(03)00167-4.
This study was undertaken to assess the relationship between acute hyperglycemia and left ventricular function after reperfusion therapy for acute myocardial infarction (AMI).
This study consisted of 529 patients with a first anterior wall AMI who underwent coronary angiography followed by coronary angioplasty or thrombolysis within 12 hours after the onset of chest pain. Plasma glucose was measured at the time of hospital admission. Acute hyperglycemia was defined as plasma glucose >10 mmol/L.
Although acute hyperglycemia was associated with both lower acute left ventricular ejection fraction (LVEF) (46% +/- 12% vs 48% +/- 10%, P =.026) and lower predischarge LVEF (51% +/- 15% vs 56% +/- 15%, P =.001), the difference was more pronounced in the latter and the change in LVEF was significantly smaller in patients with acute hyperglycemia (4.8% +/- 11.2% vs 8.0% +/- 13.8%, P =.022). Multivariable analysis showed that there was a significant correlation between plasma glucose and impaired predischarge LVEF, even after adjustment of acute LVEF (r = -0.13, P =.005). Thirty-day mortality tended to be higher in patients with acute hyperglycemia than in patients without (7.1% vs 3.5%, P =.06). Multivariable analysis showed that plasma glucose (per 1 mmol/L increase) was an independent predictor of 30-day mortality after AMI (odds ratio 1.12, 95% CI 1.03-1.22, P =.009).
Acute hyperglycemia was independently associated with impaired left ventricular function and higher 30-day mortality after AMI. These results may provide a potential explanation for poor outcomes of patients with AMI and acute hyperglycemia.
本研究旨在评估急性心肌梗死（AMI）再灌注治疗后急性高血糖与左心室功能之间的关系。
本研究纳入了529例首次发生前壁AMI的患者，这些患者在胸痛发作后12小时内接受了冠状动脉造影，随后进行了冠状动脉血管成形术或溶栓治疗。入院时测量血浆葡萄糖水平。急性高血糖定义为血浆葡萄糖>10 mmol/L。
尽管急性高血糖与较低的急性左心室射血分数（LVEF）（46%±12%对48%±10%，P = 0.026）和较低的出院前LVEF（51%±15%对56%±15%，P = 0.001）相关，但后者的差异更为明显，急性高血糖患者的LVEF变化明显更小（4.8%±11.2%对8.0%±13.8%，P = 0.022）。多变量分析显示，即使在调整急性LVEF后，血浆葡萄糖与出院前LVEF受损之间仍存在显著相关性（r = -0.13，P = 0.005）。急性高血糖患者的30天死亡率倾向于高于无急性高血糖患者（7.1%对3.5%，P = 0.06）。多变量分析显示，血浆葡萄糖（每升高1 mmol/L）是AMI后30天死亡率的独立预测因素（比值比1.12，95%可信区间1.03 - 1.22，P = 0.009）。
急性高血糖与AMI后左心室功能受损和较高的30天死亡率独立相关。这些结果可能为AMI合并急性高血糖患者预后不良提供一个潜在的解释。
