兹沃勒试验中伴或不伴糖尿病的ST段抬高型心肌梗死患者的长期临床结局

Long-term clinical outcome of ST-segment elevation myocardial infarction patients with and without diabetes mellitus in the Zwolle trial.

作者信息

Timmer J R, van der Horst I C C, Henriques J P S, Thomas K, Bilo H J G, Hoorntje J C A, de Boer M J, Suryapranata H, Zijlstra F

出版信息

Neth Heart J. 2003 Oct;11(10):387-393.

PMID:25696147

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2499982/

Abstract

OBJECTIVES

We sought to compare long-term survival after ST-segment elevation myocardial infarction (STEMI) in patients with and without diabetes mellitus (DM) treated with primary percutaneous coronary intervention (PCI) or thrombolytic therapy.

BACKGROUND

DM is an adverse prognostic factor after STEMI. However, there is only limited information about long-term clinical outcome in STEMI patients with DM treated with PCI or thrombolysis.

METHODS

Patients with STEMI (n=395) were randomised to treatment either with intravenous streptokinase or PCI. Mean follow-up was 8±2 years. We studied long-term mortality of patients with DM (n=32) and without DM (n=363) and the interaction with the treatment regimen.

RESULTS

After eight years, a total of 17 patients with DM (53%) died compared with 88 (24%) patients without DM (OR 3.5, p<0.001). Reduced left ventricular ejection fraction (LVEF) after STEMI was more often present in patients with DM compared with patients without DM (31% vs. 15%, p=0.01). Multivariate analysis revealed that DM (OR 2.6, 95% CI 1.4-4.7, p=0.002), reduced LVEF (OR 2.4, 95% CI 1.5-3.8, p<0.001) and age ≥60 years (OR 2.4, 95% CI 1.5-3.8, p<0.001) were independent risk factors for long-term mortality. Patients with DM treated with PCI had less LVEF (13% vs. 53%, p=0.01) and lower long-term mortality rates (38% vs. 69%, p=0.08) compared with treatment with thrombolysis.

CONCLUSIONS

STEMI patients with DM are a high-risk group with higher long-term mortality rates compared with patients without DM. PCI is the treatment of choice, particularly in DM patients.

摘要

目的

我们试图比较接受直接经皮冠状动脉介入治疗（PCI）或溶栓治疗的糖尿病（DM）患者与非糖尿病患者在ST段抬高型心肌梗死（STEMI）后的长期生存率。

背景

DM是STEMI后的不良预后因素。然而，关于接受PCI或溶栓治疗的STEMI合并DM患者的长期临床结局的信息有限。

方法

将STEMI患者（n = 395）随机分为静脉注射链激酶或PCI治疗组。平均随访时间为8±2年。我们研究了DM患者（n = 32）和非DM患者（n = 363）的长期死亡率以及与治疗方案的相互作用。

结果

八年后，共有17例DM患者（53%）死亡，而非DM患者有88例（24%）死亡（比值比3.5，p<0.001）。与非DM患者相比，DM患者STEMI后左心室射血分数（LVEF）降低更为常见（31%对15%，p = 0.01）。多变量分析显示，DM（比值比2.6，95%置信区间1.4 - 4.7，p = 0.002）、LVEF降低（比值比2.4，95%置信区间1.5 - 3.8，p<0.001）和年龄≥60岁（比值比2.4，95%置信区间1.5 - 3.8，p<0.001）是长期死亡率的独立危险因素。与溶栓治疗相比，接受PCI治疗的DM患者LVEF更低（13%对53%，p = 0.01），长期死亡率更低（38%对69%，p = 0.08）。