Department of Cardiology, Rigshopitalet University Hospital, Blegdamsvej, Copenhagen, Denmark.
Cardiovasc Diabetol. 2010 Jun 2;9:22. doi: 10.1186/1475-2840-9-22.
In patients hospitalized for myocardial infarction, there are limited data examining the long-term prognostic effect of diabetes. The aim of this study was to systematically evaluate the development of diabetes as an independent long-term prognostic factor after myocardial infarction.
Prospective follow-up of 6676 consecutive MI patients screened for entry in the Trandolapril Cardiac Evaluation (TRACE) study. The patients were analysed by Kaplan-Meier survival analysis, landmark analysis and Cox proportional hazard models and outcome measure was all-cause mortality.
The mortality in patients with diabetes was 82,7% at 10 years of follow-up and 91,1% at 15 years of follow-up, while patients without diabetes had a mortality of 60,2% at 10 years of follow-up and 72,9% at 15 years of follow-up (p < 0.0001). Landmark analysis continued to show prognostic significance of diabetes throughout the duration of follow-up. Multivariable Cox proportional-hazards model showed that the hazard ratio for death in patients with diabetes overall was 1.47 (95% confidence intervals (CI) 1.35-1.61) and varied between 1.19 (CI 1.04-1.37) and 2.13 (CI 1.33-3.42) in the 2-year periods of follow-up.
Diabetes is an important independent long-term prognostic factor after MI and continues to predict mortality even 17 years after index MI. This underscores the importance of aggressive diagnostic and therapeutic approach in diabetes patients with MI.
在因心肌梗死住院的患者中，关于糖尿病对长期预后影响的相关数据十分有限。本研究旨在系统性评估心肌梗死后新发糖尿病作为独立长期预后因素的作用。
前瞻性随访 6676 例连续 MI 患者，这些患者是参加 Trandolapril 心脏评估（TRACE）研究的入选者。通过 Kaplan-Meier 生存分析、标志分析和 Cox 比例风险模型对患者进行分析，终点事件为全因死亡率。
在随访 10 年时，糖尿病患者的死亡率为 82.7%，在随访 15 年时为 91.1%，而无糖尿病的患者在随访 10 年和 15 年时的死亡率分别为 60.2%和 72.9%（p < 0.0001）。标志分析结果显示，在整个随访期间，糖尿病的预后意义均具有统计学意义。多变量 Cox 比例风险模型显示，糖尿病患者的总体死亡风险比为 1.47（95%置信区间（CI）1.35-1.61），在随访的 2 年期间，风险比在 1.19（CI 1.04-1.37）和 2.13（CI 1.33-3.42）之间变化。
糖尿病是 MI 后重要的独立长期预后因素，即使在 MI 后 17 年，仍可预测死亡率。这突显了对合并 MI 的糖尿病患者采取积极诊断和治疗方法的重要性。
