Ishihara Masaharu, Kojima Sunao, Sakamoto Tomohiro, Asada Yujiro, Tei Chuwa, Kimura Kazuo, Miyazaki Shunichi, Sonoda Masahiro, Tsuchihashi Kazufumi, Yamagishi Masakazu, Ikeda Yoshihiko, Shirai Mutsunori, Hiraoka Hisatoyo, Inoue Takeshi, Saito Fumio, Ogawa Hisao
Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan.
Am Heart J. 2005 Oct;150(4):814-20. doi: 10.1016/j.ahj.2004.12.020.
This study was undertaken to assess the association between acute hyperglycemia and inhospital outcome after acute myocardial infarction (AMI) in the percutaneous coronary intervention (PCI) era. We also assessed outcome of patients with a history of diabetes mellitus in the PCI era.
Between January 2001 and December 2001, 1253 patients were admitted to the hospitals within 48 hours after the onset of AMI. Plasma glucose was measured at hospital admission. Acute hyperglycemia was defined as plasma glucose of > 11 mmol/L (198 mg/dL), regardless of the diabetic status. Primary PCI was performed in 898 (72%) patients.
The inhospital mortality rate was significantly higher in patients with acute hyperglycemia than in patients without (16% vs 6%, P < .001). However, there was no significant difference in mortality between diabetic and nondiabetic patients (8% vs 9%, P = .54). Acute hyperglycemia was associated with a higher inhospital mortality rate both in nondiabetic patients (24% vs 6%, P < .001) and in diabetic patients (10% vs 5%, P = .039). Acute hyperglycemia was associated with a higher incidence of no reflow during PCI (21% vs 12%, P < .001), but diabetes was not (14% vs 15%, P = .71).
Acute hyperglycemia, but not diabetes, was a predictor for inhospital mortality after AMI in the PCI era. No reflow occurred more frequently during PCI in patients with acute hyperglycemia, suggesting that microvascular dysfunction might have contributed to adverse outcome of these patients.
本研究旨在评估经皮冠状动脉介入治疗（PCI）时代急性心肌梗死（AMI）后急性高血糖与住院结局之间的关联。我们还评估了PCI时代糖尿病患者的结局。
2001年1月至2001年12月期间，1253例患者在AMI发病后48小时内入院。入院时测量血浆葡萄糖。急性高血糖定义为血浆葡萄糖>11 mmol/L（198 mg/dL），无论糖尿病状态如何。898例（72%）患者接受了直接PCI。
急性高血糖患者的住院死亡率显著高于非急性高血糖患者（16%对6%，P<.001）。然而，糖尿病患者和非糖尿病患者的死亡率无显著差异（8%对9%，P=.54）。急性高血糖在非糖尿病患者（24%对6%，P<.001）和糖尿病患者（10%对5%，P=.039）中均与较高的住院死亡率相关。急性高血糖与PCI期间无复流发生率较高相关（21%对12%，P<.001），但糖尿病患者并非如此（14%对15%，P=.71）。
在PCI时代，急性高血糖而非糖尿病是AMI后住院死亡率的预测因素。急性高血糖患者在PCI期间无复流更频繁发生，提示微血管功能障碍可能导致了这些患者的不良结局。
