Ritsinger V, Hero C, Svensson A M, Saleh N, Lagerqvist B, Eeg-Olofsson K, Norhammar A
1 Unit of Cardiology, Department of Medicine, Solna, Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden.
2 Department of Research and Development, Region Kronoberg, Sweden.
Eur J Prev Cardiol. 2017 May;24(8):848-857. doi: 10.1177/2047487316687860. Epub 2017 Jan 13.
Background In a modern perspective there is limited information on mortality by affected coronary vessels assessed by coronary angiography in patients with type 1 diabetes. The aim of the present study was to characterise distribution of coronary artery disease and impact on long-term mortality in patients with type 1 diabetes undergoing coronary angiography. Design The design of this research was a nationwide population-based cohort study. Methods Individuals ( n = 2776) with type 1 diabetes undergoing coronary angiography 2001-2013 included in the Swedish National Diabetes Registry and Swedish Coronary Angiography and Angioplasty Registry were followed for mortality until 31 December 2013 (mean 7.1 years). In 79% the indication was stable or acute coronary artery disease. Coronary artery disease was categorised into normal (21%), one- (23%), two- (18%), three- (29%) and left main-vessel disease (8%). Results Mean age was 57 years and 58% were male. Mean diabetes duration was 35 years, glycated haemoglobin was 67 mmol/mol and 44% had normal or one-vessel disease. In multivariate Cox proportional analyses hazard ratio for mortality compared with normal findings was 1.09 (95% confidence interval 0.80-1.48) for one, 1.43 (1.05-1.94) for two, 1.47 (1.10-1.96) for three and 1.90 (1.35-2.68) for left main-vessel disease. Renal failure 2.29 (1.77-2.96) and previous heart failure 1.76 (1.46-2.13) were highly associated with mortality. Standard mortality ratio the first year was 5.55 (4.65-6.56) and decreased to 2.80 (2.18-3.54) after five years. Conclusions In patients with type 1 diabetes referred for coronary angiography mortality is influenced by numbers of affected coronary vessels. The overall mortality rate was higher compared with the general population. These results support early intensive prevention of coronary artery disease in this population.
背景 从现代角度来看，关于1型糖尿病患者经冠状动脉造影评估的受累冠状动脉血管所致死亡率的信息有限。本研究的目的是描述1型糖尿病患者冠状动脉疾病的分布情况及其对接受冠状动脉造影患者长期死亡率的影响。设计 本研究为一项基于全国人群的队列研究。方法 纳入瑞典国家糖尿病登记处和瑞典冠状动脉造影与血管成形术登记处2001年至2013年期间接受冠状动脉造影的1型糖尿病患者（n = 2776），随访至2013年12月31日的死亡率（平均7.1年）。79%的患者指征为稳定型或急性冠状动脉疾病。冠状动脉疾病分为正常（21%）、单支血管病变（23%）、双支血管病变（18%）、三支血管病变（29%）和左主干血管病变（8%）。结果 平均年龄为57岁，58%为男性。平均糖尿病病程为35年，糖化血红蛋白为67 mmol/mol，44%患有正常或单支血管病变。在多变量Cox比例分析中，与正常结果相比，单支血管病变的死亡风险比为1.09（95%置信区间0.80 - 1.48），双支血管病变为1.43（1.05 - 1.94），三支血管病变为1.47（1.10 - 1.96），左主干血管病变为1.90（1.35 - 2.68）。肾衰竭2.29（1.77 - 2.96）和既往心力衰竭1.76（1.46 - 2.13）与死亡率高度相关。第一年的标准化死亡率为5.55（4.65 - 6.56），五年后降至2.80（2.18 - 3.54）。结论 在接受冠状动脉造影的1型糖尿病患者中，死亡率受受累冠状动脉血管数量的影响。与一般人群相比，总体死亡率更高。这些结果支持对该人群早期强化预防冠状动脉疾病。
