在两个时间段以及两个不同国家中，糖尿病病史对急性心肌梗死治疗及预后的影响。

The influence of a history of diabetes on treatment and outcome in acute myocardial infarction, during two time periods and in two different countries.

作者信息

Svensson Ann-Marie, Dellborg Mikael, Abrahamsson Putte, Karlsson Thomas, Herlitz Johan, Duval Susan J, Berger Alan K, Luepker Russell V

机构信息

Sahlgrenska University Hospital/Ostra, Göteborg, Sweden.

出版信息

Int J Cardiol. 2007 Jul 31;119(3):319-25. doi: 10.1016/j.ijcard.2006.07.156. Epub 2006 Oct 24.

DOI:10.1016/j.ijcard.2006.07.156

PMID:17067706

Abstract

AIMS

The aim of this study was to investigate the influence of diabetes on treatment and outcome in acute myocardial infarction (AMI), during two time periods, in two countries, and to assess whether this influence has changed over the past decades.

METHODS

Patients, aged 30 to 74, with a diagnosis of AMI in two urban areas--Göteborg, Sweden and Minneapolis-St. Paul, Minnesota, USA--hospitalized during 1990-1991 and 1995-1996 were included. The primary endpoint was 7-year all-cause mortality.

RESULTS

The study included 3824 patients, 734 (19%) had diabetes. Age-adjusted in-hospital mortality of diabetic patients was nearly twofold higher compared with non-diabetic patients (9.8% vs. 5.0%, p<0.05). Between 1990-1991 and 1995-1996 in-hospital mortality declined for both diabetic (11.9% vs. 7.6%, p=0.07) and non-diabetic (6.3% vs. 3.6%, p=0.002) patients. A history of diabetes was associated with nearly twofold higher long-term mortality rate (48.5% vs. 26%, p<0.05). Seven-year mortality was reduced between 1990-1991 and 1995-1996 in both diabetic (51.6% vs. 45.2%, p=0.13) and non-diabetic patients (29.3% vs. 22.1%, p<0.0001) (The results did not reach statistical significance for diabetic patients, due to smaller sample size.) During their hospital stay, diabetic patients received significantly less aspirin, beta-blockers and thrombolysis. After adjustment, a history of diabetes remained significantly associated with 7-year mortality following AMI, doubling the hazard of death (hazard ratio (HR)=2.11; 95% confidence interval (CI): 1.80-2.46).

CONCLUSION

A history of diabetes is associated with nearly twofold higher long-term mortality rate and is independently associated with 7-year mortality following AMI. Short- and long-term mortality decreased from 1990 to 1995 in both non-diabetic and diabetic patients. Underutilization of evidence-based treatments contributes to the remaining increased mortality in diabetic patients with acute coronary disease.

摘要

目的

本研究旨在调查在两个时间段、两个国家中糖尿病对急性心肌梗死（AMI）治疗及预后的影响，并评估这种影响在过去几十年中是否发生了变化。

方法

纳入年龄在30至74岁之间、于1990 - 1991年及1995 - 1996年期间在瑞典哥德堡和美国明尼苏达州明尼阿波利斯 - 圣保罗这两个城市地区住院且诊断为AMI的患者。主要终点为7年全因死亡率。

结果

该研究共纳入3824例患者，其中734例（19%）患有糖尿病。糖尿病患者经年龄调整后的住院死亡率比非糖尿病患者高出近两倍（9.8%对5.0%，p<0.05）。在1990 - 1991年至1995 - 1996年期间，糖尿病患者（11.9%对7.6%，p = 0.07）和非糖尿病患者（6.3%对3.6%，p = 0.002）的住院死亡率均有所下降。糖尿病病史与长期死亡率高出近两倍相关（48.5%对26%，p<0.05）。在1990 - 1991年至1995 - 1996年期间，糖尿病患者（51.6%对45.2%，p = 0.13）和非糖尿病患者（29.3%对22.1%，p<0.0001）的7年死亡率均有所降低（由于糖尿病患者样本量较小，结果未达到统计学显著性）。在住院期间，糖尿病患者接受阿司匹林、β受体阻滞剂和溶栓治疗的比例明显较低。调整后，糖尿病病史仍与AMI后的7年死亡率显著相关，死亡风险增加一倍（风险比（HR）=2.11；95%置信区间（CI）：1.80 - 2.46）。