Casella Gianni, Savonitto Stefano, Chiarella Francesco, Gonzini Lucio, Di Chiara Antonio, Bolognese Leonardo, De Servi Stefano, Greco Cesare, Zonzin Pietro, Coccolini Stefano, Maggioni Aldo Pietro, Boccanelli Alessandro
Ospedale Maggiore, Bologna, Italy.
Ital Heart J. 2005 May;6(5):374-83.
The determinants of a worse outcome in diabetic patients after an acute myocardial infarction (AMI) are controversial. They include delayed hospital admission, worse clinical presentation and lesser efficacy of accepted therapeutic interventions. Therefore, to improve our knowledge, we aimed to describe the clinical characteristics, treatment options and short-term outcomes of diabetic patients in a survey of consecutive AMI subjects admitted to the Italian coronary care unit (CCU) network in the current era of reperfusion.
The BLITZ study prospectively enrolled patients with AMI, within 48 hours of symptom onset, admitted to 296 out of the 341 existing Italian CCUs from October 15 to 29, 2001. Diabetic status was recorded by collecting clinical history. In-hospital and post-discharge management and outcomes were collected up to 30 days from admission.
Overall, 434 of 1959 enrolled patients (22%) had a clinical diagnosis of diabetes. Diabetic patients were older, more frequently women, had a worse coronary risk profile, and an unfavorable clinical presentation compared to non-diabetics. Among 1275 patients with ST-elevation AMI, diabetics (20%) received a similar proportion of any reperfusion therapy (61 vs 66%, p = 0.10), but significantly less primary percutaneous coronary angioplasty (9 vs 16%, p = 0.003). Diabetic patients were treated less often with oral beta-blockers than non-diabetics both during hospitalization (56 vs 64%, p = 0.003) and at discharge (54 vs 61%, p = 0.01). In contrast, in-hospital use of angiotensin-converting enzyme inhibitors (76 vs 67%, p = 0.0003), digitalis (10 vs 5%, p = 0.0005), and diuretics (54 vs 36%, p < 0.0001) was more frequent among diabetics. During their index admission, subjects with diabetes had higher in-hospital mortality (11 vs 6%, p = 0.0004), as well as higher rates of reinfarction (6 vs 2%, p = 0.0003), new congestive heart failure (28 vs 14%, p < 0.0001), cardiogenic shock (10 vs 5%, p = 0.0005) or recurrent angina (22 vs 16%, p = 0.0034). A similar pattern was observed at 30-day follow-up. At multivariate analysis, diabetic status was not confirmed to be an independent predictor of 30-day mortality.
Although diabetic patients with AMI admitted to the Italian CCU network have a higher in-hospital and 30-day morbidity and mortality rates compared to non-diabetics, a clinical diagnosis of diabetes has no independent predictive value on short-term outcome.
糖尿病患者急性心肌梗死（AMI）后预后较差的决定因素存在争议。这些因素包括住院延迟、临床表现较差以及公认治疗干预措施的疗效较低。因此，为了增进我们的了解，我们旨在描述在当前再灌注时代，意大利冠心病监护病房（CCU）网络收治的连续性AMI患者中糖尿病患者的临床特征、治疗选择和短期预后。
BLITZ研究前瞻性纳入了2001年10月15日至29日期间症状发作48小时内入住意大利341家现有CCU中296家的AMI患者。通过收集临床病史记录糖尿病状态。收集入院后30天内的住院及出院后管理情况和预后。
总体而言，1959名入组患者中有434名（22%）临床诊断为糖尿病。与非糖尿病患者相比，糖尿病患者年龄更大，女性更常见，冠状动脉风险状况更差，临床表现也不利。在1275例ST段抬高型AMI患者中，糖尿病患者（20%）接受任何再灌注治疗的比例相似（61%对66%，p = 0.10），但接受直接经皮冠状动脉介入治疗的比例显著更低（9%对16%，p = 0.003）。糖尿病患者在住院期间（56%对64%，p = 0.003）和出院时（54%对61%，p = 0.01）使用口服β受体阻滞剂的频率均低于非糖尿病患者。相比之下，糖尿病患者住院期间使用血管紧张素转换酶抑制剂（76%对67%，p = 0.0003）、洋地黄（10%对5%，p = 0.0005）和利尿剂（54%对36%，p < 0.0001）的频率更高。在其首次住院期间，糖尿病患者的住院死亡率更高（11%对6%，p = 0.0004），再梗死率（6%对2%，p = 0.0003）、新发充血性心力衰竭（28%对14%，p < 0.0001）、心源性休克（10%对5%，p = 0.0005）或复发性心绞痛（22%对16%，p = 0.0034）的发生率也更高。在30天随访时观察到类似模式。多变量分析时，糖尿病状态未被确认为30天死亡率的独立预测因素。
尽管入住意大利CCU网络的AMI糖尿病患者与非糖尿病患者相比，住院及30天的发病率和死亡率更高，但糖尿病的临床诊断对短期预后没有独立预测价值。
