Struttura Complessa di Cardiologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste, Via Valdoni 1, Trieste, Italy.
J Cardiovasc Med (Hagerstown). 2013 Feb;14(2):127-35. doi: 10.2459/JCM.0b013e32834eec7a.
The impact of diabetes in patients with acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI) is unclear. The benefit of abciximab in this subset of patients remains controversial.
Three hundred and twenty-seven consecutive and unselected patients with acute AMI treated with primary PCI were included in our single-center retrospective registry, 103 diabetic (31%) and 224 nondiabetic (69%). Abciximab was given at the physician's discretion. Diabetic patients were older (mean age 68.5±11 vs. 65±12 years; P=0.009), had an increased prevalence of hypertension (73 vs. 54%; P=0.001), a decreased prevalence of smoking (31 vs. 45%; P=0.02), a longer duration of symptoms before hospital admission (190 vs. 143 min; P=0.031), and a higher number of stents implanted (1.4 vs. 1.2; P=0.04). Other clinical and angiographic characteristics were comparable in the two groups. Diabetic patients had a higher incidence of the combined end-point of death and reinfarction rate at 30 days (18 vs. 10%; P=0.04) compared to nondiabetic patients. Abciximab treatment was associated with a lower in-hospital (23.8 vs. 5%; P=0.005) and 30-day (23.8 vs. 6.6%; P=0.012) mortality, and a lower incidence of death and reinfarction at 30 days (33.3 vs. 9.8%; P=0.003) in diabetic patients. In nondiabetic patients, abciximab was not associated with improved outcome measures. Advanced Killip class (III and IV) and abciximab were found to be independently associated with 30-day death or myocardial infarction [respectively, odds ratio (OR) 6.075, 95% confidence interval (CI) 1.59-23.218, P=0.008 and OR 0.177, 95% CI 0.034-0.938, P=0.042] in the propensity score-matched populations of diabetic patients. Advanced Killip class and thrombolysis in myocardial infarction score index were found to be independently associated with 30-day death or myocardial infarction (respectively, OR 6.607, 95% CI 1.5-29.106, P=0.013 and OR 1.094 95% CI 1.042-1.148, P<0.001) in the propensity score-matched populations of nondiabetic patients.
In our registry diabetic patients treated with primary PCI for AMI had a worse in-hospital and 30-day outcome than nondiabetic patients. Adjunct pharmacologic treatment with abciximab was associated to a better prognosis only in diabetic patients.
糖尿病患者在接受直接经皮冠状动脉介入治疗（PCI）治疗的急性心肌梗死（AMI）中的影响尚不清楚。阿昔单抗在这部分患者中的益处仍存在争议。
我们的单中心回顾性登记处纳入了 327 例连续且未经选择的接受直接 PCI 治疗的急性 AMI 患者，其中 103 例为糖尿病患者（31%），224 例为非糖尿病患者（69%）。阿昔单抗的使用由医生决定。糖尿病患者年龄更大（平均年龄 68.5±11 岁 vs. 65±12 岁；P=0.009），高血压患病率更高（73% vs. 54%；P=0.001），吸烟率更低（31% vs. 45%；P=0.02），入院前症状持续时间更长（190 分钟 vs. 143 分钟；P=0.031），植入的支架数量更多（1.4 个 vs. 1.2 个；P=0.04）。两组的其他临床和血管造影特征相当。与非糖尿病患者相比，糖尿病患者在 30 天时有更高的联合终点死亡率和再梗死率（18% vs. 10%；P=0.04）。阿昔单抗治疗与院内（23.8% vs. 5%；P=0.005）和 30 天（23.8% vs. 6.6%；P=0.012）死亡率降低以及 30 天死亡率和再梗死率降低（33.3% vs. 9.8%；P=0.003）相关。在非糖尿病患者中，阿昔单抗治疗与改善的结局指标无关。高级 Killip 分级（III 级和 IV 级）和阿昔单抗与 30 天内死亡或心肌梗死独立相关[分别为优势比（OR）6.075，95%置信区间（CI）1.59-23.218，P=0.008 和 OR 0.177，95%CI 0.034-0.938，P=0.042]，在糖尿病患者的倾向评分匹配人群中。高级 Killip 分级和心肌梗死溶栓治疗指数与 30 天内死亡或心肌梗死独立相关[分别为 OR 6.607，95%CI 1.5-29.106，P=0.013 和 OR 1.094，95%CI 1.042-1.148，P<0.001]，在非糖尿病患者的倾向评分匹配人群中。
在我们的登记处中，接受直接 PCI 治疗的 AMI 的糖尿病患者的院内和 30 天预后比非糖尿病患者差。阿昔单抗的辅助药物治疗仅与糖尿病患者的更好预后相关。
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