Angeli Fabio, Verdecchia Paolo, Karthikeyan Ganesan, Mazzotta Giovanni, Del Pinto Maurizio, Repaci Salvatore, Gatteschi Camillo, Gentile Giorgio, Cavallini Claudio, Reboldi Gianpaolo
Department of Cardiology, Hospital Santa Maria della Misericordia, 06100 Perugia - Italy.
Curr Diabetes Rev. 2010 Mar;6(2):102-10. doi: 10.2174/157339910790909413.
Patients without a history of diabetes often develop hyperglycemia during an acute coronary syndrome (ACS). New onset of hyperglycemia (NH) is associated with higher mortality both in the short and long-term.
We performed a systematic review and meta-analysis of observational studies to investigate the association between NH and mortality in patients with ACS. In-hospital, 30-day and long-term mortality were analyzed separately.
We searched MEDLINE for prospective studies of patients with ACS reporting the association between NH and mortality, using Research Methodology Filters. This was supplemented by hand searching reference lists of retrieved articles. We determined study eligibility and conducted data abstraction independently and disagreements were resolved by consensus. We pooled odds ratios (OR) from individual studies using a random effects model.
Our search strategy identified 24 studies. The prevalence of NH varied widely 3% to 71% depending on the definition of NH used. NH significantly increased the risk of in-hospital (OR 3.62, 95% CI: 3.09 - 4.24; p < 0.0001, I2=0.0%; 15 studies, 10673 patients), 30-day (OR 4.81, 95% CI: 2.18 - 10.61, p < 0.0001, I2=92.2%; 4 studies, 101447 patients), and long-term (up to 108 months) mortality (OR 2.02, 95% CI: 1.62-2.51; p < 0.0001, I2=79.4%; 12 studies, 102099 patients).
In patients without a prior diagnosis of diabetes who are admitted to hospital for ACS, NH increases the risk of both short and long-term mortality. These data highlight the need for further studies addressing the control of blood glucose levels in patients with ACS.
Patients without history of diabetes may develop new hyperglycemia (NH) on admission to hospital for AMI. We systematically reviewed the prognostic impact of NH on short- and long-term mortality in patients without prior diagnosis of diabetes who attended the hospital for ACS. We identified 24 outcome studies which met a set of pre-specified criteria. Prevalence of NH ranged from 3% to 71% according to different thresholds of blood glucose concentrations. NH significantly increased the risk of in-hospital (OR 3.62, 95% CI: 3.09 - 4.24; p < 0.0001, I2=0.0%; 15 studies, 10673 patients), 30-day (OR 4.81, 95% CI: 2.18 - 10.61, p < 0.0001, I2=92.2%; 4 studies, 101447 patients)), and long-term (up to 108 months) mortality (OR 2.02, 95% CI: 1.62-2.51; p < 0.0001, I2=79.4%; 12 studies, 102,099 patients).
既往无糖尿病史的患者在急性冠脉综合征（ACS）期间常出现高血糖。新发高血糖（NH）在短期和长期均与较高的死亡率相关。
我们对观察性研究进行了系统评价和荟萃分析，以探讨NH与ACS患者死亡率之间的关联。分别分析了住院期间、30天和长期死亡率。
我们使用研究方法过滤器在MEDLINE中检索关于ACS患者NH与死亡率关联的前瞻性研究。通过手工检索所检索文章的参考文献列表进行补充。我们独立确定研究的合格性并进行数据提取，分歧通过共识解决。我们使用随机效应模型汇总各个研究的比值比（OR）。
我们的检索策略共识别出24项研究。根据所使用的NH定义，NH的患病率差异很大，为3%至71%。NH显著增加了住院期间（OR 3.62，95%可信区间：3.09 - 4.24；p < 0.0001，I² = 0.0%；15项研究，10673例患者）、30天（OR 4.81，95%可信区间：2.18 - 10.61，p < 0.0001，I² = 92.2%；4项研究，101447例患者）和长期（长达108个月）死亡率（OR 2.02，95%可信区间：1.62 - 2.51；p < 0.0001，I² = 79.4%；12项研究，102099例患者）的风险。
对于因ACS入院且既往未诊断糖尿病的患者，NH增加了短期和长期死亡风险。这些数据凸显了进一步研究控制ACS患者血糖水平的必要性。
既往无糖尿病史的患者在因急性心肌梗死入院时可能会出现新发高血糖（NH）。我们系统评价了NH对因ACS入院且既往未诊断糖尿病患者短期和长期死亡率的预后影响。我们识别出24项符合一组预先设定标准的结局研究。根据不同的血糖浓度阈值，NH的患病率在3%至71%之间。NH显著增加了住院期间（OR 3.62，95%可信区间：3.09 - 4.24；p < 0.0001，I² = 0.0%；15项研究，10673例患者）、30天（OR 4.81，95%可信区间：2.18 - 10.61，p < 0.0001，I² = 92.2%；4项研究，101447例患者）和长期（长达108个月）死亡率（OR 2.02，95%可信区间：1.62 - 2.51；p < 0.0001，I² = 79.4%；12项研究，102099例患者）的风险。
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