Piccolo Raffaele, Franzone Anna, Koskinas Konstantinos C, Räber Lorenz, Pilgrim Thomas, Valgimigli Marco, Stortecky Stefan, Rat-Wirtzler Julie, Silber Sigmund, Serruys Patrick W, Jüni Peter, Heg Dik, Windecker Stephan
Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
Institute of Social and Preventive Medicine, Clinical Trials Unit, University of Bern, Bern, Switzerland.
Am J Cardiol. 2016 Aug 1;118(3):345-52. doi: 10.1016/j.amjcard.2016.05.005. Epub 2016 May 14.
Few data are available on the timing of adverse events in relation to the status of diabetes mellitus and the type of acute coronary syndrome (ACS). We investigated this issue in diabetic and nondiabetic patients admitted with a diagnosis of non-ST-segment elevation ACS (NSTE-ACS) or ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention. Patient-level data from 6 studies (n = 16,601) were pooled and only patients with ACS are included (n = 9,492). Early (0 to 30 days), late (31 to 365 days), and overall (0 to 365 days) events were analyzed. Diabetes mellitus was present in 1,927 patients (20.3%). At 1 year, all-cause mortality was highest for diabetic patients with STEMI (13.4%), followed by diabetic patients with NSTE-ACS (10.3%), nondiabetic patients with STEMI (6.4%) and nondiabetic patients with NSTE-ACS (4.4%; p <0.001). Among patients with diabetes, there was a significant interaction (p <0.001) for STEMI versus NSTE-ACS in early compared with late mortality, due to an excess of early mortality associated with STEMI (9.3% vs 3.7%; hazard ratio 2.31, 95% CI 1.52 to 3.54, p <0.001). Compared with diabetic NSTE-ACS patients, diabetic patients with STEMI had an increased risk of early stent thrombosis (hazard ratio 2.26, 95% CI 1.48 to 3.44, p <0.001), as well as a significant interaction (p = 0.009) in the risk of target lesion revascularization between the early and late follow-up. The distribution of fatal and nonfatal events according to the type of ACS was not influenced by diabetic status. In conclusion, diabetes in ACS setting confers a worse prognosis with 1-year mortality >10% in both STEMI and NSTE-ACS. Notwithstanding the high absolute rates, the temporal distribution of adverse events related to the type of ACS is similar between diabetic and nondiabetic patients.
关于不良事件发生时间与糖尿病状态及急性冠状动脉综合征（ACS）类型之间关系的数据很少。我们在因诊断为非ST段抬高型ACS（NSTE-ACS）或ST段抬高型心肌梗死（STEMI）而接受经皮冠状动脉介入治疗的糖尿病和非糖尿病患者中研究了这个问题。汇总了6项研究（n = 16,601）的患者水平数据，仅纳入了患有ACS的患者（n = 9,492）。分析了早期（0至30天）、晚期（31至365天）和总体（0至365天）事件。1,927名患者（20.3%）患有糖尿病。在1年时，STEMI糖尿病患者的全因死亡率最高（13.4%），其次是NSTE-ACS糖尿病患者（10.3%）、STEMI非糖尿病患者（6.4%）和NSTE-ACS非糖尿病患者（4.4%；p<0.001）。在糖尿病患者中，与晚期死亡率相比，STEMI与NSTE-ACS在早期死亡率方面存在显著交互作用（p<0.001），这是由于STEMI相关的早期死亡率过高（9.3%对3.7%；风险比2.31，95%CI 1.52至3.54，p<0.001）。与糖尿病NSTE-ACS患者相比，STEMI糖尿病患者早期支架血栓形成风险增加（风险比2.26，95%CI 1.48至3.44，p<0.001），并且在早期和晚期随访之间目标病变血运重建风险方面存在显著交互作用（p = 0.009）。根据ACS类型划分的致命和非致命事件分布不受糖尿病状态影响。总之，在ACS情况下，糖尿病预示着更差的预后，STEMI和NSTE-ACS的1年死亡率均>10%。尽管绝对发生率很高，但糖尿病和非糖尿病患者中与ACS类型相关的不良事件的时间分布相似。
