Yang Yan-Min, Liu Yao, Zhu Jun, Tan Hui-Qiong, Liang Yan, Li Ying, Li Jian-Dong, Zhang Yan, Liu Li-Sheng
Cardiovascular Institute and Fu Wai Heart Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Zhonghua Yi Xue Za Zhi. 2009 May 12;89(18):1230-3.
To evaluate the predictive value of different admission blood glucose levels for short-term mortality in patients with ST-segment elevation acute myocardial infarction (STEMI).
An observational analysis of 7446 Chinese STEMI patients from a global randomized controlled trials were recruited within 12 hours of symptom onset. According to the levels of admission glucose, these patients were divided into six groups, admission glucose < 4.50 mmol/L was defined as the hypoglycemia group; glucose of 4.5 - 5.5 mmol/L a control; 5.6 - 7.0 mmol/L, 7.1 - 8.5 mmol/L (mild hyperglycemia group) and 8.6 - 11.0 mmol/L (moderate hyperglycemia group); glucose > 11.0 mmol/L was the severe hyperglycemia group. The 30-day mortality was analyzed.
Compared with the glucose of 4.5 - 5.5 mmol/L group, thirty-day mortality increased in patients with hypoglycemia (10.2%, P < 0.05), mild and moderate hyperglycemia (9.2%, P = 0.01; 11.6%, P < 0.01, respectively) and severe hyperglycemia (18.6%, P < 0.01). The highest mortality occurred in the severe hyperglycemia group. Multivariate logistic regression analysis showed that, as compared with glucose of 4.5 - 5.5 mmol/L, the mild and the moderate hyperglycemia groups had a mortality increasing of 46% (OR 1.46, 95% CI 1.03 - 2.07, P = 0.01) and 58% fold (OR 1.58, 95% CI 1.13 - 2.22 P = 0.02) respectively; the severe hyperglycemia group had a risk of death of 2.26 folds (OR 2.26, 95% CI 1.62 - 3.14, P = 0.05). Mild, moderate and severe hyperglycemia were independent predictors of 30-day mortality.
The 30-day mortality was higher in STEMI patients with mild, moderate and severe hyperglycemia at admission. Admission blood glucose level is an important factor associated with a short-term.
评估ST段抬高型急性心肌梗死（STEMI）患者不同入院血糖水平对短期死亡率的预测价值。
对7446例来自全球随机对照试验的中国STEMI患者进行观察性分析，这些患者在症状发作后12小时内入组。根据入院血糖水平，将这些患者分为六组，入院血糖<4.50 mmol/L定义为低血糖组；血糖4.5 - 5.5 mmol/L为对照组；5.6 - 7.0 mmol/L、7.1 - 8.5 mmol/L（轻度高血糖组）和8.6 - 11.0 mmol/L（中度高血糖组）；血糖>11.0 mmol/L为重度高血糖组。分析30天死亡率。
与血糖4.5 - 5.5 mmol/L组相比，低血糖患者（10.2%，P<0.05）、轻度和中度高血糖患者（分别为9.2%，P = 0.01；11.6%，P<0.01）以及重度高血糖患者（18.6%，P<0.01）的30天死亡率升高。最高死亡率出现在重度高血糖组。多因素logistic回归分析显示，与血糖4.5 - 5.5 mmol/L相比，轻度和中度高血糖组的死亡率分别增加46%（OR 1.46，95%CI 1.03 - 2.07，P = 0.01）和58倍（OR 1.58，95%CI 1.13 - 2.22，P = 0.02）；重度高血糖组的死亡风险为2.26倍（OR 2.26，95%CI 1.62 - 3.14，P = 0.05）。轻度、中度和重度高血糖是30天死亡率的独立预测因素。
入院时存在轻度、中度和重度高血糖的STEMI患者30天死亡率较高。入院血糖水平是与短期预后相关的重要因素。
