Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan.
Cardiovasc Diabetol. 2018 Aug 18;17(1):116. doi: 10.1186/s12933-018-0761-5.
Impaired glucose metabolism is an established risk factor for coronary artery disease. Previous studies revealed that glycemic variability (GV) is also important for glucose metabolism in patients with acute coronary syndrome (ACS). We explored the association between GV and prognosis in patients with ACS.
A total of 417 patients with ACS who received reperfusion wore a continuous glucose monitoring system (CGMS) in a stable phase after admission and were monitored for at least 24 consecutive h. The mean amplitude of glycemic excursion (MAGE) was calculated as a marker of GV. We divided into two groups based on the highest tertile levels of MAGE (MAGE = 52 mg/dl). The groups were followed up for a median of 39 months [IQR 24-50 months]. The primary endpoint was the incidence of major adverse cardiovascular and cerebrovascular events (MACCE).
During follow-up, 66 patients experienced MACCE (5 patients had cardiovascular death, 14 had recurrence of ACS, 27 had angina requiring revascularization, 8 had acute decompensated heart failure, and 16 had a stroke). MACCE was more frequently observed in the high MAGE group (23.5% vs. 11.6%, p = 0.002). In multivariate analysis, high MAGE was an independent predictive factor of poor prognosis for MACCE (odds ratio, 1.84; 95% confidence interval, 1.01-3.36; p = 0.045).
Glycemic variability determined with a CGMS is a predictor of prognosis in patients with ACS without severe DM. Trial registration UMIN 000010620. Registered April 1st 2012.
糖代谢受损是冠心病的既定危险因素。先前的研究表明，血糖波动（GV）对于急性冠状动脉综合征（ACS）患者的葡萄糖代谢也很重要。我们探讨了 GV 与 ACS 患者预后之间的关系。
共纳入 417 例 ACS 患者，在入院后稳定期佩戴连续血糖监测系统（CGMS），至少连续 24 小时监测。平均血糖波动幅度（MAGE）作为 GV 的标志物进行计算。我们根据 MAGE 的最高三分位水平（MAGE=52mg/dl）将患者分为两组。中位随访时间为 39 个月[IQR 24-50 个月]。主要终点是主要不良心血管和脑血管事件（MACCE）的发生率。
在随访期间，66 例患者发生 MACCE（5 例心血管死亡，14 例 ACS 复发，27 例需要血运重建的心绞痛，8 例急性失代偿性心力衰竭，16 例卒中等）。高 MAGE 组 MACCE 发生率更高（23.5%比 11.6%，p=0.002）。多因素分析显示，高 MAGE 是 MACCE 预后不良的独立预测因素（比值比，1.84；95%置信区间，1.01-3.36；p=0.045）。
CGMS 测定的血糖波动是 ACS 合并无严重 DM 患者预后的预测指标。临床试验注册号 UMIN 000010620。注册于 2012 年 4 月 1 日。
