空腹高血糖对非糖尿病急性冠状动脉综合征患者预后的预测价值：一项前瞻性队列研究。

Prognostic values of fasting hyperglycaemia in non-diabetic patients with acute coronary syndrome: A prospective cohort study.

机构信息

Cardiology Division, Geneva University Hospitals, Switzerland.

Department of Internal Medicine, University of Genoa, Italy.

出版信息

Eur Heart J Acute Cardiovasc Care. 2020 Sep;9(6):589-598. doi: 10.1177/2048872618777819. Epub 2018 Jun 4.

DOI:10.1177/2048872618777819

PMID:29862825

Abstract

BACKGROUND

Controversy remains regarding the prevalence of hyperglycaemia in non-diabetic patients hospitalised with acute coronary syndrome and its prognostic value for long-term outcomes.

METHODS AND RESULTS

We evaluated the prevalence of hyperglycaemia (defined as fasting glycaemia ⩾10 mmol/l) among patients with no known diabetes at the time of enrolment in the prospective Special Program University Medicine-Acute Coronary Syndromes cohort, as well as its impact on all-cause death, myocardial infarction, stroke and incidence of diabetes at one year. Among 3858 acute coronary syndrome patients enrolled between December 2009-December 2014, 709 (18.4%) had known diabetes, while 112 (3.6%) of non-diabetic patients had hyperglycaemia at admission. Compared with non-hyperglycaemic patients, hyperglycaemic individuals were more likely to present with ST-elevation myocardial infarction and acute heart failure. At discharge, hyperglycaemic patients were more frequently treated with glucose-lowering agents (8.9% vs 0.66%, <0.001). At one-year, adjudicated all-cause death was significantly higher in non-diabetic patients presenting with hyperglycaemia compared with patients with no hyperglycaemia (5.4% vs 2.2%, =0.041) and hyperglycaemia was a significant predictor of one-year mortality (adjusted hazard ratio 2.39, 95% confidence interval 1.03-5.56). Among patients with hyperglycaemia, 9.8% had developed diabetes at one-year, while the corresponding proportion among patients without hyperglycaemia was 1.8% (<0.001). In multivariate analysis, hyperglycaemia at presentation predicted the onset of treated diabetes at one-year (odds ratio 4.15, 95% confidence interval 1.59-10.86; =0.004).

CONCLUSION

Among non-diabetic patients hospitalised with acute coronary syndrome, a fasting hyperglycaemia of ⩾10 mmol/l predicted one-year mortality and was associated with a four-fold increased risk of developing diabetes at one year.

摘要

背景

非糖尿病患者因急性冠脉综合征住院时出现高血糖的流行程度及其对长期预后的预测价值仍存在争议。

方法和结果

我们评估了前瞻性大学医学-急性冠脉综合征队列中登记时无已知糖尿病的患者中高血糖（空腹血糖 ⩾10mmol/l）的患病率，以及其对全因死亡、心肌梗死、卒中和一年时糖尿病发病率的影响。在 2009 年 12 月至 2014 年 12 月期间登记的 3858 例急性冠脉综合征患者中，709 例（18.4%）患有已知糖尿病，而 112 例（3.6%）非糖尿病患者入院时存在高血糖。与非高血糖患者相比，高血糖患者更有可能出现 ST 段抬高型心肌梗死和急性心力衰竭。出院时，高血糖患者更频繁地接受降血糖药物治疗（8.9%比 0.66%，<0.001）。在一年时，与无高血糖的患者相比，出现高血糖的非糖尿病患者的全因死亡显著更高（5.4%比 2.2%，=0.041），高血糖是一年死亡率的显著预测因素（调整后的危险比 2.39，95%置信区间 1.03-5.56）。在高血糖患者中，9.8%的患者在一年时出现糖尿病，而无高血糖患者的相应比例为 1.8%（<0.001）。在多变量分析中，入院时的高血糖预示着一年时接受治疗的糖尿病的发病（比值比 4.15，95%置信区间 1.59-10.86；=0.004）。