Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02445, USA.
Eur J Heart Fail. 2010 Nov;12(11):1229-37. doi: 10.1093/eurjhf/hfq179.
Diabetes is a potent risk factor for death and heart failure (HF) hospitalization following myocardial infarction (MI). Whether diabetes modifies the relationship between left ventricular ejection fraction (LVEF) and outcomes in the post-MI population is unknown.
The Valsartan in Acute Myocardial Infarction trial (VALIANT) enrolled 14 703 patients with acute MI complicated by HF, systolic dysfunction, or both. We compared the risk of death, HF hospitalization, and/or recurrent MI among patients with and without diabetes using Cox proportional hazards models. To assess the relationship between diabetes, LVEF and outcomes, we assessed the relative influence of baseline LVEF on outcomes in diabetic and non-diabetic patients. Totally, 11 325 subjects (3095 diabetics) with site-reported LVEF and known diabetes status were included. At any given LVEF, diabetes was associated with a higher risk of all-cause mortality [adjusted hazard ratio (HR) 1.37, 95% CI 1.25-1.51], death or HF hospitalization (adjusted HR 1.42, 95% CI 1.31-1.51), and death or recurrent MI (adjusted HR 1.36, 95% CI 1.24-1.48). Diabetes modified the relationship between LVEF and death or HF hospitalization (P for interaction = 0.0109), such that the association between diabetes and increased risk was greater in magnitude at higher LVEF. No interaction was noted between diabetes and LVEF on risk of all-cause mortality or death or recurrent MI.
Diabetes is associated with a higher risk of death or HF hospitalization across the spectrum of LVEF in high-risk post-MI patients. The magnitude of reduction in risk of death or HF hospitalization associated with increasing LVEF is significantly attenuated among patients with diabetes when compared to patients without diabetes.
糖尿病是心肌梗死后死亡和心力衰竭（HF）住院的一个强有力的危险因素。尚不清楚糖尿病是否改变了心肌梗死后人群左心室射血分数（LVEF）与结局之间的关系。
急性心肌梗死缬沙坦试验（VALIANT）纳入了 14703 例急性 MI 合并 HF、收缩功能障碍或两者均有的患者。我们使用 Cox 比例风险模型比较了有糖尿病和无糖尿病患者的死亡、HF 住院和/或再梗风险。为了评估糖尿病、LVEF 和结局之间的关系，我们评估了基线 LVEF 对糖尿病和非糖尿病患者结局的相对影响。共有 11325 例（3095 例糖尿病患者）有记录 LVEF 和已知糖尿病状态的患者被纳入研究。在任何给定的 LVEF 下，糖尿病与全因死亡率（校正风险比[HR]1.37，95%CI 1.25-1.51）、死亡或 HF 住院（校正 HR 1.42，95%CI 1.31-1.51）和死亡或再梗（校正 HR 1.36，95%CI 1.24-1.48）的风险增加相关。糖尿病改变了 LVEF 与死亡或 HF 住院之间的关系（P 交互=0.0109），即在更高的 LVEF 下，糖尿病与更高风险的关联程度更大。在全因死亡率或死亡或再梗风险方面，未观察到糖尿病与 LVEF 之间存在交互作用。
在高危心肌梗死后患者中，糖尿病与 LVEF 谱内的死亡或 HF 住院风险增加相关。与无糖尿病患者相比，糖尿病患者的 LVEF 增加与死亡或 HF 住院风险降低幅度明显减弱。
