University Hospital of Geneva, Geneva, Switzerland.
Eur Heart J Acute Cardiovasc Care. 2013 Dec;2(4):342-9. doi: 10.1177/2048872613490382. Epub 2013 Jun 3.
Data on temporal trends in outcomes, gender differences, and adherence to evidence-based therapy (EBT) of diabetic patients with ST-segment elevation myocardial infarction (STEMI) are sparse.
We performed a retrospective analysis of prospectively acquired data on 3565 diabetic (2412 males and 1153 females) STEMI patients enrolled in the Swiss AMIS Plus registry between 1997 and 2010 and compared in-hospital outcomes and adherence to EBT with the nondiabetic population (n=15,531).
In-hospital mortality dramatically decreased in diabetic patients, from 19.9% in 1997 to 9.0% in 2010 (p trend<0.001) with an age-adjusted decrease of 6% per year of admission. Similar trends were observed for age-adjusted reinfarction (OR 0.86, p<0.001), cardiogenic shock (OR 0.88, p<0.001), as well as death, reinfarction, or stroke (OR 0.92, p<0.001). However, the mortality benefit over time was observed in diabetic males (p trend=0.006) but not females (p trend=0.082). In addition, mortality remained twice as high in diabetic patients compared with nondiabetic ones (12.1 vs. 6.1%, p<0.001) and diabetes was identified as independent predictor of mortality (OR 1.23, p=0.022). Within the diabetic cohort, females had higher mortality than males (16.1 vs. 10.2%, p<0.001) and female gender independently predicted in-hospital mortality (OR 1.45, p=0.015). Adherence to EBT significantly improved over time in diabetic patients (p trend<0.001) but remained inferior - especially in women - to the one of nondiabetic individuals.
In-hospital mortality and morbidity of diabetic STEMI patients in Switzerland improved dramatically over time but, compared with nondiabetic counterparts, gaps in outcomes as well as EBT use persisted, especially in women.
关于糖尿病合并 ST 段抬高型心肌梗死（STEMI）患者结局的时间趋势、性别差异和循证治疗（EBT）依从性的数据较为匮乏。
我们对瑞士 AMIS Plus 注册中心于 1997 年至 2010 年间纳入的 3565 例糖尿病（2412 例男性，1153 例女性）STEMI 患者前瞻性采集的数据进行了回顾性分析，并与非糖尿病患者（n=15531 例）的院内结局和 EBT 依从性进行了比较。
糖尿病患者院内死亡率显著下降，从 1997 年的 19.9%降至 2010 年的 9.0%（趋势<0.001），入院后每年年龄校正死亡率下降 6%。类似的趋势见于年龄校正再梗死（OR 0.86，<0.001）、心源性休克（OR 0.88，<0.001）以及死亡、再梗死或卒中等复合终点（OR 0.92，<0.001）。然而，这种随时间推移的死亡率获益仅见于男性糖尿病患者（趋势=0.006），而女性患者则不然（趋势=0.082）。此外，与非糖尿病患者相比，糖尿病患者的死亡率仍然高出一倍（12.1% vs. 6.1%，<0.001），且糖尿病被确定为死亡率的独立预测因子（OR 1.23，p=0.022）。在糖尿病患者队列中，女性的死亡率高于男性（16.1% vs. 10.2%，<0.001），且女性性别独立预测院内死亡率（OR 1.45，p=0.015）。糖尿病患者的 EBT 依从性随时间显著改善（趋势<0.001），但仍逊于非糖尿病患者，尤其是女性。
瑞士糖尿病合并 STEMI 患者的院内死亡率和发病率随时间推移显著改善，但与非糖尿病患者相比，结局和 EBT 使用方面的差距仍然存在，尤其是女性。
