Department of Epidemiology, Beijing Anzhen Hospital, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
Department of Cardiology, Peking University First Hospital, Beijing, China.
Cardiovasc Diabetol. 2018 Nov 27;17(1):147. doi: 10.1186/s12933-018-0793-x.
Guidelines have classified patients with acute coronary syndrome (ACS) and diabetes as a special population, with specific sections presented for the management of these patients considering their extremely high risk. However, in China up-to-date information is lacking regarding the burden of diabetes in patients with ACS and the potential impact of diabetes status on the in-hospital outcomes of these patients. This study aims to provide updated estimation for the burden of diabetes in patients with ACS in China and to evaluate whether diabetes is still associated with excess risks of early mortality and major adverse cardiovascular and cerebrovascular events (MACCE) for ACS patients.
The Improving Care for Cardiovascular Disease in China-ACS Project was a collaborative study of the American Heart Association and the Chinese Society of Cardiology. A total of 63,450 inpatients with a definitive diagnosis of ACS were included. Prevalence of diabetes was evaluated in the overall study population and subgroups. Multivariate logistic regression was performed to examine the association between diabetes and in-hospital outcomes, and a propensity-score-matched analysis was further conducted.
Among these ACS patients, 23,880 (37.6%) had diabetes/possible diabetes. Both STEMI and NSTE-ACS patients had a high prevalence of diabetes/possible diabetes (36.8% versus 39.0%). The prevalence of diabetes/possible diabetes was higher in women (45.0% versus 35.2%, p < 0.001). Even in patients younger than 45 years, 26.9% had diabetes/possible diabetes. While receiving comparable treatments for ACS, diabetes/possible diabetes was associated with a twofold higher risk of all-cause death (adjusted odds ratio 2.04 [95% confidence interval 1.78-2.33]) and a 1.5-fold higher risk of MACCE (adjusted odds ratio 1.54 [95% confidence interval 1.39-1.72]).
Diabetes was highly prevalent in patients with ACS in China. Considerable excess risks for early mortality and major adverse cardiovascular events were found in these patients. Trial registration NCT02306616. Registered December 3, 2014.
指南将急性冠状动脉综合征（ACS）和糖尿病患者归类为特殊人群，针对这些患者极高的风险，制定了专门的管理章节。然而，目前中国缺乏有关 ACS 患者中糖尿病负担的最新信息，也不清楚糖尿病状态对这些患者住院期间结局的潜在影响。本研究旨在为中国 ACS 患者中糖尿病的负担提供最新评估，并评估糖尿病是否仍然与 ACS 患者早期死亡率和主要不良心血管和脑血管事件（MACCE）风险增加相关。
改善中国心血管疾病治疗-ACS 项目是美国心脏协会和中华医学会心血管病学分会的合作研究。共纳入 63450 例确诊为 ACS 的住院患者。评估了总体研究人群和亚组中糖尿病的患病率。采用多变量逻辑回归分析糖尿病与住院期间结局的关系，并进一步进行倾向评分匹配分析。
在这些 ACS 患者中，23880 例（37.6%）有糖尿病/可能有糖尿病。STEMI 和 NSTE-ACS 患者均有较高的糖尿病/可能有糖尿病患病率（36.8%比 39.0%）。女性的糖尿病/可能有糖尿病患病率更高（45.0%比 35.2%，p<0.001）。即使在 45 岁以下的患者中，也有 26.9%有糖尿病/可能有糖尿病。尽管接受了相当的 ACS 治疗，但糖尿病/可能有糖尿病与全因死亡风险增加两倍相关（校正比值比 2.04[95%置信区间 1.78-2.33]），与 MACCE 风险增加 1.5 倍相关（校正比值比 1.54[95%置信区间 1.39-1.72]）。
中国 ACS 患者中糖尿病患病率较高。这些患者的早期死亡率和主要不良心血管事件风险显著增加。试验注册 NCT02306616。于 2014 年 12 月 3 日注册。
