Tian Li, Zhu Jun, Liu Lisheng, Liang Yan, Li Jiandong, Yang Yanmin
State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Coron Artery Dis. 2013 Jan;24(1):16-22. doi: 10.1097/MCA.0b013e32835b3971.
Several studies to date have examined whether admission levels of hemoglobin A1c (HbA1c) correlate with short-term and long-term outcomes in patients with acute myocardial infarction treated with primary percutaneous coronary intervention (PCI). However, the results have been ambiguous. We speculated that admission levels of HbA1c correlate with short-term outcomes of patients with ST-elevation myocardial infarction (STEMI) undergoing primary PCI.
In this observational multicenter study, 608 patients with STEMI who underwent primary PCI between June 2001 and July 2004 were enrolled. Blood samples were collected upon admission to hospital for HbA1c measurement. Follow-up was carried out at 7 and 30 days after hospital admission. According to the new American Diabetes Association criteria, patients were stratified into three groups: I, HbA1c 5.6% or less (n=262); II, HbA1c 5.7-6.4% (n=182); and III, HbA1c at least 6.5% (n=164). The primary outcomes were all-cause mortality and major adverse cardiac events at follow-up.
The 7-day mortality was similar (P=0.179) between groups I (1.9%), II (2.2%), and III (0.0%); the 30-day mortality was also similar (P=0.241) between groups I (3.8%), II (2.2%), and III (1.2%). MACE at the 7- day and 30-day follow-up were not significantly different between the three groups either (P>0.05). Rates of target vessel revascularization and rehospitalization, and MACE-free survival curves, at the 30-day follow-up were also similar among the three groups. After adjusting the baseline characteristics, HbA1c was not an independent predictor of short-term outcomes (hazards ratio: 0.431; 95% confidence interval: 0.175-1.061, P=0.067).
Admission levels of HbA1c are not an independent prognostic marker for short-term outcomes in STEMI patients treated with primary PCI.
迄今为止，已有多项研究探讨了血红蛋白A1c（HbA1c）的入院水平与接受直接经皮冠状动脉介入治疗（PCI）的急性心肌梗死患者的短期和长期预后是否相关。然而，结果并不明确。我们推测，HbA1c的入院水平与接受直接PCI的ST段抬高型心肌梗死（STEMI）患者的短期预后相关。
在这项观察性多中心研究中，纳入了2001年6月至2004年7月期间接受直接PCI的608例STEMI患者。入院时采集血样以测量HbA1c。在入院后7天和30天进行随访。根据美国糖尿病协会的新标准，将患者分为三组：I组，HbA1c为5.6%或更低（n = 262）；II组，HbA1c为5.7 - 6.4%（n = 182）；III组，HbA1c至少为6.5%（n = 164）。主要结局为随访时的全因死亡率和主要不良心脏事件。
I组（1.9%）、II组（2.2%）和III组（0.0%）的7天死亡率相似（P = 0.179）；I组（3.8%）、II组（2.2%）和III组（1.2%）的30天死亡率也相似（P = 0.241）。三组在7天和30天随访时的主要不良心脏事件也无显著差异（P>0.05）。三组在30天随访时的靶血管再血管化率、再住院率以及无主要不良心脏事件生存曲线也相似。在调整基线特征后，HbA1c不是短期预后的独立预测因素（风险比：0.431；95%置信区间：0.175 - 1.061，P = 0.067）。
对于接受直接PCI治疗的STEMI患者，HbA1c的入院水平不是短期预后的独立预后标志物。
