Hasdai David, Behar Solomon, Boyko Valentina, Battler Alexander
Rabin Medical Center, Petah Tikva, Israel.
Coron Artery Dis. 2004 May;15(3):129-35. doi: 10.1097/00019501-200405000-00001.
Oral treatments for diabetes mellitus (DM) may have a deleterious effect on acute coronary syndromes (ACS) outcomes.
We aimed to examine in-hospital mortality among patients with ACS and DM and the impact of anti-DM treatment modalities.
The Euro Heart Survey ACS prospectively enrolled 10484 patients across Europe and the Mediterranean basin. Of the 10214 patients with recorded DM status, 2352 (23.0%) had DM, of whom 562 were on diet alone, 1112 received oral hypoglycaemics, 561 received insulin, and 117 received both. The in-hospital mortality for ST-elevation-ACS was 9.8 and 5.7% for patients with and without DM, respectively, with an adjusted risk (95% confidence interval) of in-hospital mortality of 1.6 (1.2, 2.1). The in-hospital mortality for non-ST-elevation-ACS was 2.8 and 2.0%, accordingly, with an adjusted risk (95% confidence interval) of in-hospital mortality of 1.2 (0.8, 1.9). The in-hospital mortality for undetermined-electrocardiographic-pattern-ACS was 11.5 and 10.9%, accordingly, with an adjusted risk of in-hospital mortality of 1.1 (0.6, 2.0). Among DM patients with ST-elevation-ACS, the adjusted risks of in-hospital mortality were 1.0 for diet therapy, 0.8 (0.4, 1.5) for oral hypoglycaemics, and 1.9 (1.0, 3.8) for insulin; for DM patients and non-ST-elevation-ACS, 1.0 for diet therapy, 2.2 (0.6, 7.8) for oral hypoglycaemics, and 3.5 (1.0, 12.5) for insulin; for DM patients and undetermined-electrocardiographic-pattern-ACS, the adjusted risks of in-hospital mortality were 1.0 for diet therapy, 0.9 (0.2, 4.6) for oral hypoglycaemics, and 2.1 (0.5, 9.5) for insulin.
Acute coronary syndrome patients with DM, especially those with ST-elevation, had increased in-hospital mortality. Among ACS patients with DM, those receiving insulin had worse outcomes. Outcomes were similar for those on hypoglycaemics or on diet alone.
糖尿病（DM）的口服治疗可能对急性冠脉综合征（ACS）的预后产生有害影响。
我们旨在研究ACS合并DM患者的院内死亡率以及抗DM治疗方式的影响。
欧洲心脏调查ACS前瞻性纳入了欧洲和地中海盆地的10484例患者。在记录了DM状态的10214例患者中，2352例（23.0%）患有DM，其中562例仅接受饮食治疗，1112例接受口服降糖药治疗，561例接受胰岛素治疗，117例两者都接受。ST段抬高型ACS患者的院内死亡率在有DM和无DM患者中分别为9.8%和5.7%，院内死亡的调整风险（95%置信区间）为1.6（1.2，2.1）。非ST段抬高型ACS患者的院内死亡率相应为2.8%和2.0%，院内死亡的调整风险（95%置信区间）为1.2（0.8，1.9）。心电图模式未确定的ACS患者的院内死亡率相应为11.5%和10.9%，院内死亡的调整风险为1.1（0.6，2.0）。在ST段抬高型ACS的DM患者中，饮食治疗的院内死亡调整风险为1.0，口服降糖药为0.8（0.4，1.5），胰岛素为1.9（1.0，3.8）；对于DM合并非ST段抬高型ACS患者，饮食治疗为1.0，口服降糖药为2.2（0.6，7.8），胰岛素为3.5（1.0，12.5）；对于DM合并心电图模式未确定的ACS患者，饮食治疗的院内死亡调整风险为1.0，口服降糖药为0.9（0.2，4.6），胰岛素为2.1（0.5，9.5）。
DM合并ACS患者，尤其是ST段抬高型患者，院内死亡率增加。在DM合并ACS患者中，接受胰岛素治疗的患者预后较差。接受降糖药治疗或仅接受饮食治疗的患者预后相似。
