Jiménez-Navarro Manuel F, Fernández-Pastor Julia, Garrido-Sánchez Lourdes, Molina-Mora María J, Ortiz-García Carmen, Alonso-Briales Juan H, Pérez-Cabeza Alejandro, Hernández-García Jose M, de Teresa-Galván Eduardo, Tinahones Francisco J
Unidad de Gestion Clinica del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, University of Malaga, Malaga, Spain, Red de Investigación Cardiovascular (RIC); 2Medicine Department, School of Medicine, University of Malaga, Spain.
Cardiol J. 2015;22(1):44-51. doi: 10.5603/CJ.a2014.0024. Epub 2014 Mar 27.
Clinical practice guidelines recommend ad hoc screening of diabetes in patients admitted for macrovascular disease; however, these recommendations are rarely followed in real practice. This study was undertaken to assess whether impaired glucose metabolism, newly diagnosed after percutaneous coronary intervention (PCI) or known diabetes, provides prognostic information.
We studied 374 patients who underwent PCI. An oral glucose tolerance test was carried out in the known non-diabetic patients with fasting glucose < 7 mmol/L.
Eighty-one percent of the patients presented impaired glucose metabolism, from which 35.3% were previously diagnosed with diabetics, 21.4% were newly detected diabetics, and 24.3% were pre-diabetics. After a mean follow-up of 35.8 ± 13.4 months, only a known history of diabetes was an independent predictor of revascularization (OR = 2.03, p = 0.025), non-fatal acute myocardial infarction (OR = 2.70, p = 0.029) and readmission due to heart failure during the follow-up (OR = 3.82, p = 0.022).
Screening for impaired glucose metabolism after PCI permits the detection of a high proportion of patients with abnormal glucose regulations. However, previously known diabetes remains the only independent predictor of cardiovascular events in the follow-up.
临床实践指南建议对因大血管疾病入院的患者进行糖尿病临时筛查；然而，在实际临床中这些建议很少被遵循。本研究旨在评估经皮冠状动脉介入治疗（PCI）后新诊断的糖代谢受损或已知糖尿病患者是否能提供预后信息。
我们研究了374例接受PCI的患者。对空腹血糖<7 mmol/L的已知非糖尿病患者进行口服葡萄糖耐量试验。
81%的患者存在糖代谢受损，其中35.3%既往被诊断为糖尿病患者，21.4%为新诊断的糖尿病患者，24.3%为糖尿病前期患者。平均随访35.8±13.4个月后，仅已知糖尿病史是血运重建（OR = 2.03，p = 0.025）、非致命性急性心肌梗死（OR = 2.70，p = 0.029）和随访期间因心力衰竭再次入院（OR = 3.82，p = 0.022）的独立预测因素。
PCI后筛查糖代谢受损可发现很大一部分血糖调节异常的患者。然而，既往已知的糖尿病仍然是随访期间心血管事件的唯一独立预测因素。
