Department of Internal Medicine, Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul, Korea.
J Korean Med Sci. 2013 Dec;28(12):1749-55. doi: 10.3346/jkms.2013.28.12.1749. Epub 2013 Nov 26.
This study was performed to evaluate the effects of diabetes on short- and mid-term clinical outcomes in patients with acute myocardial infarction (AMI). Between October 2005 and December 2009, a total of 22,347 patients with AMI from a nationwide registry was analyzed. At the time point of the day 30 after AMI onset, landmark analyses were performed for the development of major adverse cardiovascular events (MACEs), including death, re-infarction and revascularization. In this cohort, 6,131 patients (27.4%) had diabetes. Short-term MACEs, which occurred within 30 days of AMI onset, were observed in 1,364 patients (6.1%). Among the 30-day survivors (n = 21,604), mid-term MACEs, which occurred between 31 and 365 days after AMI onset, were observed in 1,181 patients (5.4%). After adjustment for potential confounders, diabetes was an independent predictor of mid-term MACEs (HR, 1.25; 95% CI, 1.08-1.45; P = 0.002), but not of short-term MACEs (HR: 1.16; 95% CI: 0.93-1.44; P = 0.167). Diabetes is a poor prognostic factor for mid-term clinical outcomes but not for short-term outcomes in AMI patients. Careful monitoring and intensive care should be considered in diabetic patients, especially following the acute stage of AMI.
本研究旨在评估糖尿病对急性心肌梗死（AMI）患者短期和中期临床结局的影响。在 2005 年 10 月至 2009 年 12 月期间，对来自全国注册登记处的 22347 例 AMI 患者进行了分析。在 AMI 发病后 30 天的时间点，对主要不良心血管事件（MACE）的发生进行了里程碑式分析，包括死亡、再梗死和血运重建。在该队列中，6131 例患者（27.4%）患有糖尿病。短期 MACE 发生在 AMI 发病后 30 天内，共 1364 例（6.1%）。在 30 天存活者（n=21604）中，中期 MACE 发生在 AMI 发病后 31 至 365 天之间，共 1181 例（5.4%）。在校正潜在混杂因素后，糖尿病是中期 MACE 的独立预测因素（HR，1.25；95%CI，1.08-1.45；P=0.002），但不是短期 MACE 的独立预测因素（HR：1.16；95%CI：0.93-1.44；P=0.167）。糖尿病是 AMI 患者中期临床结局的不良预后因素，但不是短期结局的不良预后因素。应考虑在糖尿病患者中进行仔细监测和强化护理，特别是在 AMI 的急性阶段之后。
