Franklin Kristen, Goldberg Robert J, Spencer Frederick, Klein Werner, Budaj Andrzej, Brieger David, Marre Michel, Steg Philippe Gabriel, Gowda Neelam, Gore Joel M
Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester 01655, USA.
Arch Intern Med. 2004 Jul 12;164(13):1457-63. doi: 10.1001/archinte.164.13.1457.
There are limited data describing the presenting characteristics, management, and outcomes of diabetic and nondiabetic patients with an acute coronary syndrome (ACS).
To examine differences in these factors, patients with ST-segment elevation acute myocardial infarction, non-ST-segment elevation acute myocardial infarction, and unstable angina were enrolled in a large multinational coronary disease registry.
The Global Registry of Acute Coronary Events is a prospective observational study of patients hospitalized with an ACS at 94 hospitals in 14 countries. The study sample consisted of 5403 patients with ST-segment elevation acute myocardial infarction, 4725 with non-ST-segment elevation acute myocardial infarction, and 5988 with unstable angina.
Approximately 1 in 4 patients presented to participating hospitals with a history of diabetes. Patients with diabetes were older, more often women, with a greater prevalence of comorbidities, and they were less likely to be treated with effective cardiac therapies than nondiabetic patients. Patients with diabetes who developed an ACS were at increased risk for each hospital outcome examined including heart failure, renal failure, cardiogenic shock, and death. These differences remained after adjustment for potentially confounding prognostic factors.
A considerable proportion of patients with an ACS has diabetes and is at increased risk for adverse outcomes compared with patients without diabetes. There are certain proven therapeutic strategies that remain underused in the diabetic population. A more widespread awareness of this increased risk and a more diligent use of proven cardiac treatment approaches are indicated for patients with diabetes who develop an ACS.
描述急性冠状动脉综合征（ACS）糖尿病患者和非糖尿病患者的临床表现、治疗及预后的数据有限。
为研究这些因素的差异，将ST段抬高型急性心肌梗死、非ST段抬高型急性心肌梗死和不稳定型心绞痛患者纳入一项大型跨国冠心病注册研究。
全球急性冠状动脉事件注册研究是一项对14个国家94家医院收治的ACS患者进行的前瞻性观察性研究。研究样本包括5403例ST段抬高型急性心肌梗死患者、4725例非ST段抬高型急性心肌梗死患者和5988例不稳定型心绞痛患者。
约四分之一的患者因糖尿病史就诊于参与研究的医院。糖尿病患者年龄更大，女性更多，合并症患病率更高，与非糖尿病患者相比，接受有效心脏治疗的可能性更小。发生ACS的糖尿病患者发生包括心力衰竭、肾衰竭、心源性休克和死亡在内的各项医院不良结局的风险均增加。在对潜在的混杂预后因素进行调整后，这些差异仍然存在。
相当一部分ACS患者患有糖尿病，与非糖尿病患者相比，其不良结局风险增加。某些已证实的治疗策略在糖尿病患者中仍未得到充分应用。对于发生ACS的糖尿病患者，需要更广泛地认识到这种增加的风险，并更积极地使用已证实的心脏治疗方法。
