高血糖在心肌梗死和直接经皮冠状动脉腔内血管成形术中的预后意义。

Prognostic implication of hyperglycemia in myocardial infarction and primary angioplasty.

作者信息

Worthley Matthew I, Shrive Fiona M, Anderson Todd J, Traboulsi Mouhieddin

机构信息

Foothills Interventional Cardiology Service, Department of Cardiovascular Sciences and the Libin Cardiovascular Institute, Calgary, Alberta.

出版信息

Am J Med. 2007 Jul;120(7):643.e1-7. doi: 10.1016/j.amjmed.2006.06.043.

DOI:10.1016/j.amjmed.2006.06.043

PMID:17602940

Abstract

PURPOSE

The study assessed the relationship of admission blood glucose level to in-hospital mortality in patients presenting with an ST-segment elevation myocardial infarction and treated with primary angioplasty.

METHODS

A total of 980 patients presenting with an ST-segment elevation myocardial infarction and treated exclusively with primary angioplasty were evaluated. Patients were divided into quartiles based on their admission blood glucose level: group 1 (< or =6.6 mmol/L [< or =119 mg/dL]), group 2 (6.7-7.8 mmol/L [120-140 mg/dL]), group 3 (7.9-10.0 mmol/L [141-180 mg/dL], and group 4 (> or =10.1 mmol/L [> or =181 mg/dL]. The primary end point was in-hospital mortality.

RESULTS

The mean age of the patient cohort was 62 years, 260 (27%) of whom were female. The mean admission blood glucose level was 9.1+/-4.4 mmol/L (164+/-79 mg/dL). At admission, 16% of this group were known to have diabetes. The in-hospital mortality rate was 3.8% (n=37), 5.2% in the diabetic group (n=8) and 3.5% (n=29) in the nondiabetic group. In-hospital mortality rates were significantly increased in patients with an elevated admission blood glucose level (P<.001). The in-hospital deaths in each admission blood glucose level quartile were 0.4% (n=1) in group 1, 2% (n=6) in group 2, 2% (n=6) in group 3, and 10% (n=24) in group 4.

CONCLUSIONS

In this cohort of patients who were admitted with an ST-segment elevation myocardial infarction and treated exclusively with primary angioplasty, elevated admission blood glucose level is significantly associated with an increase in in-hospital mortality.

摘要

目的

本研究评估了ST段抬高型心肌梗死患者接受直接经皮冠状动脉腔内血管成形术（primary angioplasty）治疗时，入院血糖水平与院内死亡率之间的关系。

方法

对980例ST段抬高型心肌梗死且仅接受直接经皮冠状动脉腔内血管成形术治疗的患者进行了评估。根据入院血糖水平将患者分为四分位数组：第1组（≤6.6 mmol/L[≤119 mg/dL]），第2组（6.7 - 7.8 mmol/L[120 - 140 mg/dL]），第3组（7.9 - 10.0 mmol/L[141 - 180 mg/dL]），第4组（≥10.1 mmol/L[≥181 mg/dL]）。主要终点是院内死亡率。

结果

患者队列的平均年龄为62岁，其中260例（27%）为女性。平均入院血糖水平为9.1±4.4 mmol/L（164±79 mg/dL）。入院时，该组中有16%已知患有糖尿病。院内死亡率为3.8%（n = 37），糖尿病组为5.2%（n = 8），非糖尿病组为3.5%（n = 29）。入院血糖水平升高的患者院内死亡率显著增加（P <.001）。各入院血糖水平四分位数组的院内死亡人数在第1组为0.4%（n = 1），第2组为2%（n = 6），第3组为2%（n = 6），第4组为10%（n = 24）。