Stavanger University Hospital, Stavanger, Norway.
Nancy University Hospital, Nancy, France.
Eur J Heart Fail. 2017 May;19(5):635-642. doi: 10.1002/ejhf.797.
To examine the impact of diabetes mellitus on long-term clinical outcomes in patients with myocardial infarction (MI) complicated by clinical signs of heart failure (HF) or left ventricular dysfunction (LVD).
The High-Risk MI Database consists of individual data from 28 771 patients and was created by merging four large recent randomized clinical trials (VALIANT, EPHESUS, OPTIMAAL, and CAPRICORN) that each examined the impact of pharmacological interventions following MI in patients with evidence of HF or LVD. The mean age of patients was 65 years, 70% were male, and almost 94% Caucasian. Overall, 7368 (26%) had a history of diabetes. All the major outcomes were adjudicated by independent end-point committees. Strong and highly significant associations were found with all major clinical outcomes. Diabetes was associated with an increased risk for all-cause death [adjusted hazard ratio (HR) 1.37; confidence interval (CI) 1.28-1.46; P < 0.001]. The higher risk for all-cause death was largely mediated by higher risk for cardiovascular death (adjusted HR 1.38; CI 1.27-1.48; P < 0.001) predominantly due to a substantially increased risk for fatal re-infarction (adjusted HR 1.78; CI 1.42-2.23; P < 0.001). Additionally, diabetes was associated with an increased risk for hospitalizations, particularly HF hospitalization (adjusted HR 1.50; CI 1.39-1.63; P < 0.001). There were also elevated risks for composite outcomes, particularly death or hospitalization due to HF (adjusted HR 1.48; CI 1.38-1.59; P < 0.001).
The risk for adverse outcomes associated with diabetes remains elevated even after debut of coronary artery disease in patients with MI complicated by clinical signs of HF or LVD. This association is particularly strong for HF-related outcomes.
研究糖尿病对伴有心力衰竭（HF）或左心室功能障碍（LVD）临床征象的心肌梗死（MI）患者长期临床结局的影响。
高危 MI 数据库包含 28771 例患者的个体数据，通过合并四项大型近期随机临床试验（VALIANT、EPHESUS、OPTIMAL 和 CAPRICORN）的数据创建，这些试验均研究了 MI 后伴有 HF 或 LVD 证据的患者接受药物干预对结局的影响。患者平均年龄为 65 岁，70%为男性，近 94%为白种人。总体而言，7368 例（26%）有糖尿病史。所有主要结局均由独立终点委员会裁定。所有主要临床结局均与糖尿病存在显著且强烈的相关性。糖尿病与全因死亡风险增加相关[校正后的危险比（HR）1.37；置信区间（CI）1.28-1.46；P < 0.001]。全因死亡风险增加主要归因于心血管死亡风险增加（校正 HR 1.38；CI 1.27-1.48；P < 0.001），主要是由于致命性再梗死风险显著增加（校正 HR 1.78；CI 1.42-2.23；P < 0.001）。此外，糖尿病与住院风险增加相关，尤其是 HF 住院风险增加（校正 HR 1.50；CI 1.39-1.63；P < 0.001）。复合结局（尤其是 HF 相关死亡或住院）的风险也有所升高（校正 HR 1.48；CI 1.38-1.59；P < 0.001）。
即使在 MI 患者伴有 HF 或 LVD 的临床征象后出现冠状动脉疾病，糖尿病相关不良结局的风险仍持续升高。这种相关性在 HF 相关结局中尤其强烈。
