Liu Yao, Yang Yan-min, Zhu Jun, Tan Hui-qiong, Liang Yan, Liu Li-sheng, Li Ying
Department of Emergency, Chinese Academy of Medical Sciences, Beijing 100037, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2009 Jul;37(7):590-4.
To evaluate the impact of admission blood glucose level on 30-day mortality in ST-segment elevation acute myocardial infarction (STEMI) patients with or without known diabetes.
This observational analysis enrolled 7446 Chinese STEMI patients hospitalized within 12 hours of symptom onset joining a global randomized controlled trial. The patients with or without known diabetes were divided into different groups by the admission blood glucose level: < 6.1 mmol/L (n = 2018), 6.1 to 7.7 mmol/L (n = 2170), 7.8 to 11.0 mmol/L (n = 1929), 11.1 to 13.0 mmol/L (n = 465), > 13.0 mmol/L (n = 864), the last three groups were defined as the hyperglycemia group. The 30-day mortality was analyzed.
A substantial proportion of hyperglycemic patients did not have recognized diabetes. Insulin use during hospitalization in hyperglycemic patients without known diabetes was significantly lower than that in known diabetics with similar glucose levels. Incidence of 30-day mortality increased in proportion to increasing admission glucose levels in patients without known diabetes (glucose< 6.1 mmol/L 6.8%, 6.1 to 7.7 mmol/L 8.3%, glucose > 13.0 mmol/L 18.6%, P < 0.001). In patients with known diabetes, the 30-day mortality was 16.7% with admission glucose < 6.1 mmol/L and 8.2% with admission glucose 6.1 to 7.7 mmol/L, and 22.0% with admission glucose > 13.0 mmol/L (P < 0.001). Except in patients with admission glucose > 13.0 mmol/L, the 30-day mortality was significantly higher in patients without known diabetes than in patients with known diabetes at comparable admission glucose levels (all P < 0.05).
Comparing with the known diabetic patients, admission hyperglycemia is common in STEMI patients without known diabetes and was associated with higher 30-day mortality compared to known diabetes patients with comparable admission glucose level with the exception of admission glucose level > 13.0 mmol/L.
评估入院血糖水平对伴或不伴已知糖尿病的ST段抬高型急性心肌梗死（STEMI）患者30天死亡率的影响。
这项观察性分析纳入了7446例在症状发作12小时内住院的中国STEMI患者，这些患者同时参与了一项全球随机对照试验。根据入院血糖水平，将伴或不伴已知糖尿病的患者分为不同组：<6.1 mmol/L（n = 2018）、6.1至7.7 mmol/L（n = 2170）、7.8至11.0 mmol/L（n = 1929）、11.1至13.0 mmol/L（n = 465）、>13.0 mmol/L（n = 864），后三组定义为高血糖组。分析30天死亡率。
相当一部分高血糖患者并无已确诊的糖尿病。无已知糖尿病的高血糖患者住院期间胰岛素使用率显著低于血糖水平相似的已知糖尿病患者。无已知糖尿病患者的30天死亡率随入院血糖水平升高而增加（血糖<6.1 mmol/L为6.8%，6.1至7.7 mmol/L为8.3%，血糖>13.0 mmol/L为18.6%，P<0.001）。在已知糖尿病患者中，入院血糖<6.1 mmol/L时30天死亡率为16.7%，入院血糖6.1至7.7 mmol/L时为8.2%，入院血糖>13.0 mmol/L时为22.0%（P<0.001）。除入院血糖>13.0 mmol/L的患者外，在可比的入院血糖水平下，无已知糖尿病患者的30天死亡率显著高于已知糖尿病患者（均P<0.05）。
与已知糖尿病患者相比，入院时高血糖在无已知糖尿病的STEMI患者中很常见，并且与可比入院血糖水平的已知糖尿病患者相比，30天死亡率更高，但入院血糖水平>13.0 mmol/L的情况除外。
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