急性心肌梗死治疗中的再灌注是否能改善糖尿病患者急性心肌梗死的预后？

Does reperfusion in the treatment of acute myocardial infarction improve the prognosis of acute myocardial infarction in diabetic patients?

作者信息

Janion Marianna, Polewczyk Anna, Gasior Mariusz, Gierlotka Marek, Poloński Lech

机构信息

Swietokrzyskie Centrum Kardiologii, Kielce, Poland.

出版信息

Clin Cardiol. 2009 Sep;32(9):E51-5. doi: 10.1002/clc.20428.

DOI:10.1002/clc.20428

PMID:19645045

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6652818/

Abstract

BACKGROUND

Diabetic patients have a 6-fold increased mortality in acute coronary syndromes.

HYPOTHESIS

Different therapeutic strategies in diabetics with acute coronary syndromes have an impact on in-hospital and long-term prognosis.

METHODS

A total of 889 consecutive patients with ST-segment elevation myocardial infarction were included and followed-up for at least 6 months. The study population consisted of 168 (18.9%) diabetic patients and 721 nondiabetics.

RESULTS

Invasive therapy and fibrinolysis were less frequently used in diabetic patients (38.7% versus 50.2%; p = 0.0071 and 8.3% versus 15%; p = 0.024, respectively). In-hospital mortality in diabetic individuals was almost twice as high as in nondiabetic subjects (20.2% versus 11.1%; p < 0.0014). In-hospital mortality was slightly higher in diabetic patients undergoing primary percutaneous transluminal coronary angioplasty (PTCA; 8.3% versus 4.8%; p = 0.35), but lower in those treated with fibrinolysis (7.7% versus 16%; p = 0.7) compared with the rest of the patients. At 6-mo follow-up mortality was significantly higher in diabetic subjects as compared with nondiabetic subjects (28.0% versus 15.1%; p < 0.0001). The highest number of deaths was found in individuals receiving conservative treatment with diabetic subjects significantly outnumbering nondiabetic individuals (40.1% versus 27.9%; p = 0.028 at 6 mo). Both in-hospital and 6-mo mortality were similar in diabetics and nondiabetics receiving reperfusion therapy (7.1% versus 8.2%; p < 0.68 and 9.3% versus 15.3%; p < 0.098, respectively).

CONCLUSION

Reperfusion therapy, both fibrinolysis and the invasive approach, reduced in-hospital mortality from that observed in nondiabetic individuals.

摘要

背景

糖尿病患者急性冠状动脉综合征的死亡率增加6倍。

假设

糖尿病急性冠状动脉综合征患者的不同治疗策略对住院及长期预后有影响。

方法

共纳入889例连续的ST段抬高型心肌梗死患者并随访至少6个月。研究人群包括168例（18.9%）糖尿病患者和721例非糖尿病患者。

结果

糖尿病患者较少采用侵入性治疗和溶栓治疗（分别为38.7%对50.2%；p = 0.0071以及8.3%对15%；p = 0.024）。糖尿病患者的住院死亡率几乎是非糖尿病患者的两倍（20.2%对11.1%；p < 0.0014）。接受直接经皮冠状动脉腔内血管成形术（PTCA）的糖尿病患者住院死亡率略高（8.3%对4.8%；p = 0.35），但与其他患者相比，接受溶栓治疗的患者住院死亡率较低（7.7%对16%；p = 0.7）。在6个月随访时，糖尿病患者的死亡率显著高于非糖尿病患者（28.0%对15.1%；p < 0.0001）。接受保守治疗的患者死亡人数最多，其中糖尿病患者明显多于非糖尿病患者（6个月时为40.1%对27.9%；p = 0.028）。接受再灌注治疗的糖尿病患者和非糖尿病患者的住院及6个月死亡率相似（分别为7.1%对8.2%；p < 0.68以及9.3%对15.3%；p < 0.098）。