Gierach Joanna, Gierach Marcin, Świątkiewicz Iwona, Woźnicki Marek, Grześk Grzegorz, Sukiennik Adam, Koziñski Marek, Kubica Jacek
Department of Cardiology, Regional Specialist Hospital, Grudziadz, Poland.
Department of Endocrinology and Diabetology, Collegium Medicum, Nicolaus Copernicus University, ul. Marii Skłodowskiej-Curie 9, 85-094, Bydgoszcz, Poland.
Heart Vessels. 2016 Mar;31(3):298-307. doi: 10.1007/s00380-014-0610-8. Epub 2014 Dec 25.
Carbohydrate metabolism disorder in patients hospitalized due to acute ST-segment elevation myocardial infarction (STEMI) is associated with poor outcome. The association is even stronger in non-diabetic patients compared to the diabetics. Poor outcome of patients with elevated parameters of carbohydrate metabolism may be associated with negative impact of these disorders on left ventricular (LV) function. The aim of the study was to determine the impact of admission glycemia on LV systolic function in acute phase and 6 months after myocardial infarction in STEMI patients treated with primary angioplasty, without carbohydrate disorders. The study group consisted of 52 patients (9 female, 43 male) aged 35-74 years, admitted to the Department of Cardiology and Internal Medicine, Collegium Medicum in Bydgoszcz, due to the first STEMI treated with primary coronary angioplasty with stent implantation, without diabetes in anamnesis and carbohydrate metabolism disorders diagnosed during hospitalization. Echocardiography was performed in all patients in acute phase and 6 months after MI. Plasma glucose were measured at hospital admission. In the subgroup with glycemia ≥7.1 mmol/l, in comparison to patients with glycemia <7.1 mmol/l, significantly lower ejection fraction (EF) was observed in acute phase of MI (44.4 ± 5.4 vs. 47.8 ± 6.3 %, p = 0.04) and trend to lower EF 6 months after MI [47.2 ± 6.5 vs. 50.3 ± 6.3 %, p = 0.08 (ns)]. Higher admission glycemia in patients with STEMI and without carbohydrate metabolism disturbances, may be a marker of poorer prognosis resulting from lower LV ejection fraction in the acute phase and in the long-term follow-up.
因急性ST段抬高型心肌梗死（STEMI）住院患者的碳水化合物代谢紊乱与不良预后相关。与糖尿病患者相比，非糖尿病患者中的这种关联更强。碳水化合物代谢参数升高的患者预后不良可能与这些紊乱对左心室（LV）功能的负面影响有关。本研究的目的是确定入院时血糖水平对接受直接血管成形术治疗且无碳水化合物紊乱的STEMI患者心肌梗死后急性期和6个月时左心室收缩功能的影响。研究组由52例患者（9例女性，43例男性）组成，年龄在35 - 74岁之间，因首次STEMI入住比得哥什医学院心脏病学和内科，接受冠状动脉直接血管成形术并植入支架治疗，既往无糖尿病史且住院期间未诊断出碳水化合物代谢紊乱。所有患者在急性期和心肌梗死后6个月均进行了超声心动图检查。入院时测量血浆葡萄糖。在血糖≥7.1 mmol/l的亚组中，与血糖<7.1 mmol/l的患者相比，心肌梗死急性期观察到射血分数（EF）显著降低（44.4±5.4 vs. 47.8±6.3%，p = 0.04），心肌梗死后6个月EF有降低趋势[47.2±6.5 vs. 50.3±6.3%，p = 0.08（无统计学意义）]。STEMI且无碳水化合物代谢紊乱患者入院时较高的血糖水平，可能是急性期和长期随访中左心室射血分数降低导致预后较差的一个标志。
