在接受经皮冠状动脉介入治疗的ST段抬高型心肌梗死合并心源性休克患者中，入院血糖水平是既往无糖尿病诊断患者1年死亡率的强有力独立预测因素。

In patients with ST-segment elevation myocardial infarction with cardiogenic shock treated with percutaneous coronary intervention, admission glucose level is a strong independent predictor for 1-year mortality in patients without a prior diagnosis of diabetes.

作者信息

Vis Marije M, Sjauw Krischan D, van der Schaaf René J, Baan Jan, Koch Karel T, DeVries J Hans, Tijssen Jan G P, de Winter Robbert J, Piek Jan J, Henriques José P S

机构信息

Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.

出版信息

Am Heart J. 2007 Dec;154(6):1184-90. doi: 10.1016/j.ahj.2007.07.028. Epub 2007 Sep 12.

DOI:10.1016/j.ahj.2007.07.028

PMID:18035093

Abstract

BACKGROUND

Primary percutaneous coronary intervention (PCI) reduces mortality in patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). Despite PCI, mortality in CS is still approximately 50%. Admission glucose concentration is an independent predictor of mortality in patients with STEMI and is associated with the occurrence of CS. Whether admission glucose is also a predictor of mortality in CS patients treated with primary PCI is unexplored. We therefore assessed the relation between admission glucose concentration and 1-year mortality in patients with STEMI with CS without a prior diagnosis of diabetes on admission and treated with PCI.

METHODS

We investigated a cohort of 208 consecutive patients with STEMI without a prior diagnosis of diabetes with CS on admission. Patients were classified according to glucose levels at admission: <7.8 mmol/L (group 1, n = 57), 7.8 to 11 mmol/L (group 2, n = 71), and >11.0 mmol/L (group 3, n = 80).

RESULTS

The overall 1-year mortality was 38%. One-year mortality was 21%, 27%, and 60% in groups I, II, and III, respectively (P < .001). In a multivariate logistic regression analysis, the odds for mortality increased by 16% for every 1 mmol/L increase in plasma glucose concentration (OR 1.155, 95% CI 1.070-1.247), after adjustment for left ventricular ejection fraction <40%, age older than 75 years, male sex, and thrombolysis in myocardial infarction 3 flow after PCI.

CONCLUSIONS

In patients with STEMI with CS and without a prior diagnosis of diabetes undergoing primary PCI, admission glucose concentration is a very strong independent predictor for 1-year mortality. Further studies are warranted to determine whether concomitant glycometabolic regulation in patients with STEMI treated with PCI, particularly those with CS, will improve clinical outcome.

摘要

背景

直接经皮冠状动脉介入治疗（PCI）可降低ST段抬高型心肌梗死（STEMI）合并心源性休克（CS）患者的死亡率。尽管进行了PCI治疗，但CS患者的死亡率仍约为50%。入院时血糖浓度是STEMI患者死亡率的独立预测因素，且与CS的发生相关。入院血糖是否也是接受直接PCI治疗的CS患者死亡率的预测因素尚未得到探讨。因此，我们评估了入院时未预先诊断为糖尿病且接受PCI治疗的STEMI合并CS患者的入院血糖浓度与1年死亡率之间的关系。

方法

我们调查了208例入院时未预先诊断为糖尿病且合并CS的连续STEMI患者队列。患者根据入院时的血糖水平分类：<7.8 mmol/L（第1组，n = 57），7.8至11 mmol/L（第2组，n = 71），以及>11.0 mmol/L（第3组，n = 80）。

结果

总体1年死亡率为38%。第1、2和3组的1年死亡率分别为21%、27%和60%（P <.001）。在多因素逻辑回归分析中，在校正左心室射血分数<40%、年龄大于75岁、男性以及PCI术后心肌梗死溶栓3级血流后，血浆葡萄糖浓度每升高1 mmol/L，死亡几率增加16%（OR 1.155，95% CI 1.070 - 1.247）。