[中国非ST段抬高型急性冠状动脉综合征糖尿病患者的临床特征、治疗及预后]

[Clinical characteristics, treatments and outcome of diabetic patients with non-ST elevation acute coronary syndromes in China].

作者信息

Yu Li-tian, Tan Hui-qiong, Zhu Jun, Zhang Yan, Li Jian-dong, Liu Li-sheng

机构信息

Emergency Center, Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2011 May;39(5):390-6.

PMID:21781590

Abstract

OBJECTIVE

To observe the clinical characteristics, treatment options and outcome of diabetic patients with non-ST elevation acute coronary syndromes (NSTEACS).

METHODS

Consecutive patients admitted with NSTEACS from 38 centers in north China were enrolled. Medical histories, clinical characteristics, treatments and outcomes were evaluated and follow-up was made at 6, 12, and 24 months after their initial hospital admission. Cumulative event rates were compared between diabetic and non-diabetic patients.

RESULTS

There were 420 diabetic patients out of 2294 NSTEACS patients (18.3%). Diabetic patients were older [(64.9 ± 6.7) years vs. (62.3 ± 8.6) years, P < 0.01], more often women (48.1% vs. 35.3%, P < 0.05) and were associated with higher baseline comorbidities such as previous hypertension, myocardial infarction, congestive heart failure and stroke than non-diabetic patients. The incidence of antiplatelet therapy (92.1% vs. 95.0%, P < 0.05), coronary angiography (30.0% vs. 36.3%, P < 0.05) and revascularization (12.1% vs.18.8%, P < 0.05) was lower in patients with diabetes than non-diabetic patients. In hospital and 2-year mortality as well as the incidence of congestive heart failure and composite outcomes of myocardial infarction, stroke, congestive heart failure and death were substantially higher in diabetic patients compared with non-diabetic patients. Multivariate Cox regression analysis revealed that age ≥ 70 years, diabetes, previous myocardial infarction, previous congestive heart failure, systolic blood pressure less than 90 mm Hg (1 mm Hg = 0.133 kPa) and heart rate more than 100 bpm at admission were risk factors for 2-year death.

CONCLUSION

In NSTEACS, diabetes is associated with higher rate of in-hospital and 2-year death, congestive heart failure and composite outcomes of myocardial infarction, stroke, congestive heart failure and death. Diabetes mellitus is a major independent predictor of 2-year mortality post NSTEACS. Status of antiplatelet therapy, coronary angiography and revascularization should be improved for diabetic patients with NSTEACS during hospitalization.

摘要

目的

观察糖尿病合并非ST段抬高急性冠脉综合征（NSTEACS）患者的临床特征、治疗方案及预后。

方法

纳入华北地区38个中心连续收治的NSTEACS患者。评估患者的病史、临床特征、治疗情况及预后，并在首次入院后6个月、12个月和24个月进行随访。比较糖尿病患者和非糖尿病患者的累积事件发生率。

结果

2294例NSTEACS患者中，糖尿病患者有420例（18.3%）。糖尿病患者年龄更大[（64.9±6.7）岁 vs.（62.3±8.6）岁，P<0.01]，女性比例更高（48.1% vs. 35.3%，P<0.05），且与非糖尿病患者相比，基线合并症如既往高血压、心肌梗死、充血性心力衰竭和中风的发生率更高。糖尿病患者抗血小板治疗（92.1% vs. 95.0%，P<0.05）、冠状动脉造影（30.0% vs. 36.3%，P<0.05）和血运重建（12.1% vs.18.8%，P<0.05）的发生率低于非糖尿病患者。与非糖尿病患者相比，糖尿病患者的院内死亡率、2年死亡率以及充血性心力衰竭的发生率和心肌梗死、中风、充血性心力衰竭和死亡的复合结局显著更高。多因素Cox回归分析显示，年龄≥70岁、糖尿病、既往心肌梗死、既往充血性心力衰竭、收缩压低于90 mmHg（1 mmHg = 0.133 kPa）以及入院时心率超过100次/分钟是2年死亡的危险因素。