Goldberg Robert J, Kramer Daniel G, Lessard Darleen, Yarzebski Jorge, Gore Joel M
Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
Coron Artery Dis. 2007 Mar;18(2):125-31. doi: 10.1097/01.mca.0000236291.79306.98.
Elevated serum glucose levels are associated with an increased risk of adverse outcomes in patients with diabetes in the setting of acute myocardial infarction. It is, however, unclear whether a similar association exists in nondiabetic patients and whether this relationship is changing over time. The objectives of this population-based investigation were to examine the magnitude of elevated glucose levels in patients with acute myocardial infarction and the association between admission serum glucose levels and hospital outcomes in patients not known to have prior diabetes.
The sample consisted of 3601 patients without a history of prior diabetes who were hospitalized with acute myocardial infarction at all greater Worcester (Massachusetts) medical centers in five biennial periods between 1995 and 2003.
The average age of our study population was 70 years, 59% were men, and the average glucose level at the time of hospital admission was 149 mg/dl. Approximately one-third of patients presented with glucose levels<120 mg/dl, whereas one-quarter had serum glucose levels>or=160 mg/dl. Patients in the uppermost quintiles of serum glucose were significantly more likely to develop heart failure and cardiogenic shock, and die during hospitalization than patients with lower serum glucose levels. Patients with the highest glucose levels were less aggressively treated with effective cardiac medications and coronary interventions.
The results of this population-based investigation provide insights into the magnitude and impact of hyperglycemia in patients not known to have prior diabetes who are hospitalized with acute myocardial infarction. Increased surveillance and more aggressive treatment strategies are needed to improve the outlook of patients with elevated serum glucose levels.
在急性心肌梗死情况下，糖尿病患者血清葡萄糖水平升高与不良结局风险增加相关。然而，尚不清楚非糖尿病患者中是否存在类似关联，以及这种关系是否随时间变化。这项基于人群的调查目的是研究急性心肌梗死患者血糖水平升高的程度，以及既往无糖尿病患者入院时血清葡萄糖水平与住院结局之间的关联。
样本包括1995年至2003年期间五个双年度在伍斯特（马萨诸塞州）所有大型医疗中心因急性心肌梗死住院的3601例无糖尿病病史患者。
我们研究人群的平均年龄为70岁，59%为男性，入院时平均血糖水平为149mg/dl。约三分之一患者血糖水平<120mg/dl，而四分之一患者血清葡萄糖水平≥160mg/dl。血清葡萄糖处于最高五分位数的患者比血清葡萄糖水平较低的患者更易发生心力衰竭和心源性休克，且住院期间死亡风险更高。血糖水平最高的患者接受有效心脏药物和冠状动脉介入治疗的积极性较低。
这项基于人群的调查结果为既往无糖尿病但因急性心肌梗死住院患者高血糖的程度和影响提供了见解。需要加强监测并采取更积极的治疗策略以改善血清葡萄糖水平升高患者的预后。
