入院时的血糖水平可预测行经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死合并心原性休克患者的院内和长期死亡率。

Blood glucose level on admission determines in-hospital and long-term mortality in patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock treated with percutaneous coronary intervention.

机构信息

Department of Cardiology, Silesian Medical University, Zabrze, Poland.

出版信息

Kardiol Pol. 2010 Jul;68(7):743-51.

PMID:20648428

Abstract

BACKGROUND

It has been shown that hyperglycaemia is associated with increased in-hospital and long-term mortality in patients with myocardial infarction (MI). There are only a few reports on the relationship between glycaemia in the acute phase of MI complicated by cardiogenic shock (CS) and prognosis.

AIM

To assess the relationship between blood glucose level on admission and in-hospital as well as long-term mortality in patients with acute ST-segment elevation MI (STEMI) complicated by CS treated with percutaneous coronary intervention (PCI).

METHODS

Consecutive patients with STEMI complicated by CS treated with PCI were included. For the purpose of this analysis, the patients were divided into two groups: the first group included patients with glycaemia on admission < 7.8 mmol/L, and the other group patients with glycaemia > or = 7.8 mmol/L (hyperglycaemia group). Selected parameters from the in-hospital and long-term follow-up were compared between the two groups. Due to a possible linear relationship between blood glucose and mortality in multivariate analysis, glucose level on admission was treated as a continuous variable. The primary outcomes included in-hospital, 1-year and 5-year mortality.

RESULTS

Out of 3166 consecutive patients with STEMI, 258 had CS and available data on glycaemia. In patients with hyperglycaemia on admission, we observed higher in-hospital (41.5% vs 28%, p = 0.041), 1-year (51.4% vs 34.7%, p = 0.015) and 5-year (65.8% vs 43.3%, p = 0.034) mortality in comparison to the patients with blood glucose < 7.8 mmol/L. The multivariate analysis revealed that blood glucose level on admission (per each glycaemia increment by 1 mmol/L) was an independent prognostic factor of in-hospital (OR 1.08, 95% CI 1.02-1.14, p = 0.0044), 1-year (HR 1.04, 95% CI 1.01-1.06, p = 0.005) and 5-year mortality (HR 1.03, 95% CI 1.01-1.05, p = 0.045). Of note, the diagnosis of diabetes mellitus had no influence on in-hospital and long-term mortality.

CONCLUSIONS

Elevated blood glucose level on admission, regardless of the diagnosis of diabetes mellitus, results in increased in-hospital and long-term mortality in patients with STEMI complicated by CS and treated with PCI.

摘要

背景

研究表明，高血糖与心肌梗死（MI）患者住院期间和长期死亡率增加有关。只有少数报告研究了并发心源性休克（CS）的 MI 急性期血糖与预后之间的关系。

目的

评估经皮冠状动脉介入治疗（PCI）治疗的急性 ST 段抬高型心肌梗死（STEMI）并发 CS 患者入院时和住院期间以及长期血糖水平与死亡率的关系。

方法

连续纳入接受 PCI 治疗的 STEMI 并发 CS 的患者。为了进行本分析，将患者分为两组：第一组包括入院时血糖<7.8mmol/L 的患者，另一组包括血糖≥7.8mmol/L（高血糖组）的患者。比较两组患者的住院期间和长期随访中的各项参数。由于血糖与死亡率在多变量分析中可能存在线性关系，因此将入院时的血糖水平作为连续变量处理。主要结局包括住院期间、1 年和 5 年死亡率。

结果

在 3166 例连续的 STEMI 患者中，258 例并发 CS 且有血糖数据。入院时高血糖的患者，住院期间（41.5%比 28%，p=0.041）、1 年（51.4%比 34.7%，p=0.015）和 5 年（65.8%比 43.3%，p=0.034）死亡率更高。多变量分析显示，入院时血糖水平（每升高 1mmol/L）是住院期间（OR 1.08，95%CI 1.02-1.14，p=0.0044）、1 年（HR 1.04，95%CI 1.01-1.06，p=0.005）和 5 年死亡率（HR 1.03，95%CI 1.01-1.05，p=0.045）的独立预后因素。值得注意的是，糖尿病的诊断对住院期间和长期死亡率没有影响。