Arnold Suzanne V, Lipska Kasia J, Li Yan, McGuire Darren K, Goyal Abhinav, Spertus John A, Kosiborod Mikhail
Saint Luke's Mid America Heart Institute, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO.
Yale University School of Medicine, New Haven, CT.
Am Heart J. 2014 Oct;168(4):466-470.e1. doi: 10.1016/j.ahj.2014.06.023. Epub 2014 Jul 11.
Patients with an acute myocardial infarction (AMI) who have glucose abnormalities are at increased risk for death and adverse ischemic outcomes. The contemporary prevalence of glucose abnormalities among AMI patients in the United States, as determined by hemoglobin A1c (HbA1c), is unknown.
Patients hospitalized with AMI in a 24-site US AMI registry from 2005 to 2008 were examined for the presence of dysglycemia using HbA1c, which was analyzed at a core laboratory. Patients were categorized by American Diabetes Association guidelines as having diabetes (HbA1c ≥ 6.5%), prediabetes (HbA1c 5.7%-6.4%), or normoglycemia. Baseline demographic, clinical, and metabolic characteristics, as well as long-term all-cause mortality, were compared among groups.
Among 2,853 patients with AMI, 1,083 (38%) had diabetes, of which 196 (18%) were newly diagnosed. There were an additional 887 patients (31%) with prediabetes and 883 patients (31%) who had normal glucose metabolism. Patients with metabolic abnormalities were older, were more frequently female, and had higher prevalence of cardiac and noncardiac comorbidities, including multivessel disease and left ventricular systolic dysfunction. Patients with increasing metabolic abnormalities had higher mortality over the 3 years after the AMI (8.6% in those with normoglycemia, 10.6% in prediabetes, 11.3% in newly diagnosed diabetes, and 20.3% in known diabetes; log rank P < .001).
In a large US AMI registry, we found that nearly 7 in 10 patients had dysglycemia, with 38% having diabetes and an additional 31% with prediabetes based on HbA1c levels. Over half of the patients who did not have a known diagnosis of diabetes at the time of admission had either newly diagnosed diabetes or prediabetes. Progressively greater severity of dysglycemia was also associated with incremental increase in long-term mortality. These data highlight the AMI hospitalization as a key opportunity to screen for glucose abnormalities so that appropriate interventions and patient education efforts can be implemented prior to discharge.
急性心肌梗死（AMI）患者若存在血糖异常，其死亡风险及不良缺血性结局的风险会增加。目前尚不清楚美国通过糖化血红蛋白（HbA1c）测定的AMI患者中血糖异常的当代患病率。
对2005年至2008年在美国24个地点的AMI登记处住院的患者，使用在核心实验室分析的HbA1c检测血糖异常情况。根据美国糖尿病协会指南，将患者分为患有糖尿病（HbA1c≥6.5%）、糖尿病前期（HbA1c 5.7%-6.4%）或血糖正常。比较各组患者的基线人口统计学、临床和代谢特征以及长期全因死亡率。
在2853例AMI患者中，1083例（38%）患有糖尿病，其中196例（18%）为新诊断病例。另外有887例患者（31%）患有糖尿病前期，883例患者（31%）葡萄糖代谢正常。代谢异常患者年龄较大，女性更为常见，心脏和非心脏合并症的患病率更高，包括多支血管病变和左心室收缩功能障碍。代谢异常程度增加的患者在AMI后3年的死亡率更高（血糖正常者为8.6%，糖尿病前期为10.6%，新诊断糖尿病为11.3%，已知糖尿病为20.3%；对数秩检验P<0.001）。
在美国一个大型AMI登记处中，我们发现近十分之七的患者存在血糖异常，基于HbA1c水平，38%患有糖尿病，另有31%患有糖尿病前期。超过一半入院时未确诊糖尿病的患者患有新诊断的糖尿病或糖尿病前期。血糖异常的严重程度逐渐增加也与长期死亡率的逐步上升相关。这些数据凸显了AMI住院是筛查血糖异常的关键时机，以便在出院前实施适当的干预措施和患者教育工作。
