Patel Peysh A, Cubbon Richard M, Sapsford Robert J, Gillott Richard G, Grant Peter J, Witte Klaus K, Kearney Mark T, Hall Alistair S
Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, The University of Leeds, Clarendon Way, Leeds LS2 9JT, United Kingdom.
Department of Cardiology, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom.
Int J Cardiol. 2016 Jan 15;203:141-4. doi: 10.1016/j.ijcard.2015.10.094. Epub 2015 Oct 22.
Diabetes mellitus (DM) is an established adverse prognostic factor in patients sustaining myocardial infarction (MI). However, its impact on long-term survival remains less clear. The aim of this observational study was to quantify lifetime mortality and years of life lost after MI in patients with and without DM.
In 1995, 2153 individuals with MI were recruited from 20 adjacent hospitals within Yorkshire, UK. Median survival, all-cause mortality at 20 years and lost years of life when compared to actuarial predictions were compared in patients with and without DM. Landmark analyses were conducted to define the ongoing impact of DM beyond specified time points.
13% (279/2153) had known DM. They experienced higher mortality at 30 days (33.1% vs 24.6%; p<0.0001) and at 20 years (84.9% vs 75.7%; p<0.0001). Overall, there was a 48% increased risk of death (p<0.0001), which persisted after adjustment for potential confounders. There was no interaction between DM and prior MI in predicting mortality (p=0.67). Median survival decreased by 3.3 years (p<0.0001). The adverse impact of DM persisted in sequential landmark analyses at 1, 5 and 10 years. Presence of DM conferred 2 extra years of life lost when compared with actuarial predictions (8 vs 6 years; p<0.0001).
DM remains an independent adverse prognostic factor in the long-term after MI. Persistently diverging survival curves support enduring efforts to reduce mortality late after MI.
糖尿病（DM）是心肌梗死（MI）患者既定的不良预后因素。然而，其对长期生存的影响仍不太明确。这项观察性研究的目的是量化伴或不伴糖尿病的心肌梗死患者的终生死亡率和心肌梗死后失去的生命年数。
1995年，从英国约克郡的20家相邻医院招募了2153例心肌梗死患者。比较了伴或不伴糖尿病患者的中位生存期、20年全因死亡率以及与精算预测相比失去的生命年数。进行了标志性分析以确定糖尿病在特定时间点之后的持续影响。
13%（279/2153）的患者患有已知糖尿病。他们在30天时的死亡率更高（33.1%对24.6%；p<0.0001），在20年时的死亡率也更高（84.9%对75.7%；p<0.0001）。总体而言，死亡风险增加了48%（p<0.0001），在对潜在混杂因素进行调整后仍然存在。在预测死亡率方面，糖尿病与既往心肌梗死之间没有相互作用（p=0.67）。中位生存期缩短了3.3年（p<0.0001）。在1年、5年和10年的连续标志性分析中，糖尿病的不利影响持续存在。与精算预测相比，糖尿病的存在导致多失去2年生命（8年对6年；p<0.0001）。
糖尿病在心肌梗死后的长期内仍然是一个独立的不良预后因素。持续不同的生存曲线支持为降低心肌梗死后晚期死亡率而做出的持久努力。
