Donahoe Sean M, Stewart Garrick C, McCabe Carolyn H, Mohanavelu Satishkumar, Murphy Sabina A, Cannon Christopher P, Antman Elliott M
Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, New York, USA.
JAMA. 2007 Aug 15;298(7):765-75. doi: 10.1001/jama.298.7.765.
The worldwide epidemic of diabetes mellitus is increasing the burden of cardiovascular disease, the leading cause of death among persons with diabetes. The independent effect of diabetes on mortality following acute coronary syndromes (ACS) is uncertain.
To evaluate the influence of diabetes on mortality following ACS using a large database spanning the full spectrum of ACS.
DESIGN, SETTING, AND PATIENTS: A subgroup analysis of patients with diabetes enrolled in randomized clinical trials that evaluated ACS therapies. Patients with ACS in 11 independent Thrombolysis in Myocardial Infarction (TIMI) Study Group clinical trials from 1997 to 2006 were pooled, including 62,036 patients (46,577 with ST-segment elevation myocardial infarction [STEMI] and 15,459 with unstable angina/non-STEMI [UA/NSTEMI]), of whom 10 613 (17.1%) had diabetes. A multivariable model was constructed to adjust for baseline characteristics, aspects of ACS presentation, and treatments for the ACS event.
Mortality at 30 days and 1 year following ACS among patients with diabetes vs patients without diabetes.
Mortality at 30 days was significantly higher among patients with diabetes than without diabetes presenting with UA/NSTEMI (2.1% vs 1.1%, P < .001) and STEMI (8.5% vs 5.4%, P < .001). After adjusting for baseline characteristics and features and management of the ACS event, diabetes was independently associated with higher 30-day mortality after UA/NSTEMI (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.24-2.56) or STEMI (OR, 1.40; 95% CI, 1.24-1.57). Diabetes at presentation with ACS was associated with significantly higher mortality 1 year after UA/NSTEMI (hazard ratio [HR], 1.65; 95% CI, 1.30-2.10) or STEMI (HR, 1.22; 95% CI, 1.08-1.38). By 1 year following ACS, patients with diabetes presenting with UA/NSTEMI had a risk of death that approached patients without diabetes presenting with STEMI (7.2% vs 8.1%).
Despite modern therapies for ACS, diabetes confers a significant adverse prognosis, which highlights the importance of aggressive strategies to manage this high-risk population with unstable ischemic heart disease.
全球糖尿病流行正增加心血管疾病负担，而心血管疾病是糖尿病患者的主要死因。糖尿病对急性冠脉综合征（ACS）后死亡率的独立影响尚不确定。
利用涵盖全谱ACS的大型数据库评估糖尿病对ACS后死亡率的影响。
设计、设置和患者：对参与评估ACS治疗的随机临床试验的糖尿病患者进行亚组分析。汇总了1997年至2006年11项独立的心肌梗死溶栓（TIMI）研究组临床试验中的ACS患者，包括62036例患者（46577例ST段抬高型心肌梗死[STEMI]和15459例不稳定型心绞痛/非STEMI[UA/NSTEMI]），其中10613例（17.1%）患有糖尿病。构建多变量模型以调整基线特征、ACS表现方面以及ACS事件的治疗情况。
糖尿病患者与非糖尿病患者ACS后30天和1年的死亡率。
患有UA/NSTEMI的糖尿病患者30天死亡率显著高于非糖尿病患者（2.1%对1.1%，P<.001），患有STEMI的糖尿病患者30天死亡率也显著高于非糖尿病患者（8.5%对5.4%，P<.001）。在调整基线特征、ACS事件的特点及管理后，糖尿病与UA/NSTEMI（比值比[OR]，1.78；95%置信区间[CI]，1.24 - 2.56）或STEMI（OR，1.40；95%CI，1.24 - 1.57）后30天较高死亡率独立相关。ACS发病时患有糖尿病与UA/NSTEMI（风险比[HR]，1.65；95%CI，1.30 - 2.10）或STEMI（HR，1.22；95%CI，1.08 - 1.38）后1年显著较高死亡率相关。到ACS后1年时，患有UA/NSTEMI的糖尿病患者的死亡风险接近患有STEMI的非糖尿病患者（7.2%对8.1%）。
尽管有针对ACS的现代治疗方法，但糖尿病仍带来显著不良预后，这凸显了积极策略管理这一不稳定缺血性心脏病高危人群的重要性。
