Department of Cardiovascular Sciences, Centro Cardiologico Monzino, I.R.C.C.S, University of Milan, Milan, Italy.
Am Heart J. 2010 Dec;160(6):1170-7. doi: 10.1016/j.ahj.2010.09.022.
Acute hyperglycemia and contrast-induced nephropathy (CIN) are frequently observed in ST-elevation acute myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), and both are associated with an increased mortality rate. We investigated the possible association between acute hyperglycemia and CIN in patients undergoing primary PCI.
We prospectively enrolled 780 STEMI patients undergoing primary PCI. For each patient, plasma glucose levels were assessed at hospital admission. Acute hyperglycemia was defined as glucose levels>198 mg/dL (11 mmol/L). Contrast-induced nephropathy was defined as an increase in serum creatinine>25% from baseline in the first 72 hours.
Overall, 148 (19%) patients had acute hyperglycemia; and 113 (14.5%) patients developed CIN. Patients with acute hyperglycemia had a 2-fold higher incidence of CIN than those without acute hyperglycemia (27% vs 12%, P<.001). In-hospital mortality was higher in patients with acute hyperglycemia than in those without acute hyperglycemia (12% vs 3%, P<.001). Mortality rate was also higher in patients developing CIN than in those without this renal complication (27% vs 0.9%, P<.001). Patients with acute hyperglycemia that developed CIN had the highest mortality rate (38%). Acute hyperglycemia was an independent predictor of CIN and in-hospital mortality.
In STEMI patients undergoing primary PCI, acute hyperglycemia is associated with an increased risk for CIN and with increased in-hospital mortality.
急性高血糖和对比剂诱导的肾病（CIN）在接受直接经皮冠状动脉介入治疗（PCI）的 ST 段抬高型急性心肌梗死（STEMI）患者中很常见，两者均与死亡率增加有关。我们研究了直接 PCI 患者中急性高血糖与 CIN 之间的可能关联。
我们前瞻性纳入了 780 名接受直接 PCI 的 STEMI 患者。每位患者入院时评估血浆葡萄糖水平。急性高血糖定义为血糖水平>198mg/dL（11mmol/L）。对比剂诱导的肾病定义为首次 72 小时内血清肌酐从基线升高>25%。
总体而言，148 名（19%）患者发生急性高血糖；113 名（14.5%）患者发生 CIN。与无急性高血糖的患者相比，发生急性高血糖的患者 CIN 的发生率高 2 倍（27%比 12%，P<.001）。发生急性高血糖的患者住院死亡率高于无急性高血糖的患者（12%比 3%，P<.001）。发生 CIN 的患者死亡率也高于无此肾脏并发症的患者（27%比 0.9%，P<.001）。发生急性高血糖和 CIN 的患者死亡率最高（38%）。急性高血糖是 CIN 和住院死亡率的独立预测因子。
在接受直接 PCI 的 STEMI 患者中，急性高血糖与 CIN 风险增加和住院死亡率增加相关。
