Xing Zhi, Zhang Lei, Liu Zhiqiang, He Pengyi, Yang Yuchun, Wulasihan Muhuyati
NO 2 Cadre Wards Medicine Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China.
Medicine (Baltimore). 2017 Nov;96(45):e8362. doi: 10.1097/MD.0000000000008362.
Glucose metabolism status may play a predictive role in the severity of the complications among patients with type 2 diabetes mellitus (DM). However, few studies have focused on the prognostic value of glycosylated hemoglobin (HbA1c) and Homeostatic Model Assessment 2 for Insulin Resistance (HOMA2-IR) in patients with DM, non-ST-segment elevation infarction (NSTEMI), and single concomitant chronic total occlusion (CTO) following primary percutaneous coronary intervention (PCI). Short- and long-term prognostic value of HbA1c and HOMA2-IR in patients with DM with NSTEMI and single CTO who received primary percutaneous transluminal coronary intervention (pPCI).Data from 202 patients with NSTEMI and single CTO in nonculprit vessels were included. The incidence of revascularization, cardiogenic shock, ischemic stroke, major bleeding (ie, cerebral hemorrhage or massive hemorrhage of gastrointestinal tract), and cardiac death were combined as composite end points (CEPs). HbA1c was measured on admission and at 12 and 24 weeks after discharge. HOMA2-IR was measured on admission and at 6 and 12 weeks after discharge. The mean value of HbA1c and HOMA2-IR was calculated to determine the impact on 2.5-year CEPs. All patients were assessed during hospitalization and followed for up to 2.5 years after discharge.Mean age was 62.4 ± 11.8 years and 76% were male. Previous MI, lower left ventricular ejection fraction, and higher HbA1c (hazard ratio [HR] = 1.216; 95% confidence interval [CI] = 1.023-1.445; P = .023) were independently associated with a poor prognosis at 2.5 years. Higher HbA1c and HOMA2-IR on admission was associated with CEPs during hospitalization. Mean HOMA2-IR prior to pPCI was associated with revascularization (HR = 1.129; 95% CI = 1.008-1.265; P = .036) and ischemic stroke (HR = 1.276; 95% CI = 1.044-1.560; P = .017) during the 2.5 years follow-up period.Glucose metabolism status reflected by HbA1c and HOMA2-IR may provide prognostic value to patients with NSTEMI, type 2 DM, and single concomitant CTO following PCI. Therefore, patients with NSTEMI, CTO, and poor glycemic control should be carefully evaluated prior to PCI.
葡萄糖代谢状态可能在2型糖尿病（DM）患者并发症的严重程度中起预测作用。然而，很少有研究关注糖化血红蛋白（HbA1c）和胰岛素抵抗稳态模型评估2（HOMA2-IR）在糖尿病、非ST段抬高型心肌梗死（NSTEMI）和初次经皮冠状动脉介入治疗（PCI）后伴有单一慢性完全闭塞（CTO）患者中的预后价值。HbA1c和HOMA2-IR在接受直接经皮腔内冠状动脉介入治疗（pPCI）的NSTEMI和单一CTO糖尿病患者中的短期和长期预后价值。纳入了202例非罪犯血管发生NSTEMI和单一CTO的患者的数据。将血运重建、心源性休克、缺血性中风、大出血（即脑出血或胃肠道大出血）和心源性死亡的发生率合并为复合终点（CEPs）。在入院时以及出院后12周和24周测量HbA1c。在入院时以及出院后6周和12周测量HOMA2-IR。计算HbA1c和HOMA2-IR的平均值以确定其对2.5年复合终点的影响。所有患者在住院期间进行评估，并在出院后随访长达2.5年。平均年龄为62.4±11.8岁，76%为男性。既往心肌梗死、较低的左心室射血分数和较高的HbA1c（风险比[HR]=1.216；95%置信区间[CI]=1.023-1.445；P=0.023）与2.5年时的不良预后独立相关。入院时较高的HbA1c和HOMA2-IR与住院期间的复合终点相关。pPCI前的平均HOMA2-IR与2.
