[糖尿病及血糖水平对接受经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者治疗结果的影响]

[Impact of Diabetes Mellitus and blood glucose levels on the results of treatment of patients with ST-elevation myocardial infarction undergoing percutaneous coronary interventions].

作者信息

Bessonov I S, Kuznetsov V A, Ziryanov I P, Sapozhnikov S S, Potolinskaya Yu V

机构信息

"Tyumen Cardiology Research Center", Branch of the Federal State Budgetary Science Institution "Tomsk National Research Medical Center of the Russian Academy of Sciences", Melnikayte 111, Tyumen 625026.

出版信息

Kardiologiia. 2019 Apr 13;59(3S):16-22. doi: 10.18087/cardio.2520.

DOI:10.18087/cardio.2520

PMID:30990148

Abstract

UNLABELLED

The aim of this study was to evaluate the impact of diabetes mellitus (DM) and glucose levels on the results of treatment of patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary interventions (PCIs).

MATERIALS AND METHODS

Data were collected from all patients (n=1280) with STEMI who were admitted to the coronary care unit and underwent PCIs from 2006 to 2015. 212 (16.6%) patients with DM were compared with 1068 (83.4%) patients without DM (non-DM group). To investigate the influence of the blood glucose levels, all patients were divided into two groups above and below the median of blood glycemia (7.52 mmol/l).

RESULTS

Thus, 634 patients with high level of blood glycemia (>7.52 mmol/l) were compared with 635 patients with low level of blood glycemia (≤7.52 mmol/l). In comparing of DM and non-DM groups there were no differences in the rate of death (5.2% vs 4.2%, р=0.526), stent thrombosis (1.4% vs 1.0%, р=0.622), recurrent myocardial infarction (MI) (1.4% vs 1.2%, р=0.813) and major adverse cardiac events (MACE) (7.5% vs 5.4%, р=0.228), which included in-hospital death, recurrent MI and stent thrombosis. The rates of angiographic success (92.9% vs 93.8%, р=0.625) and no-reflow (6.6% vs 5%, р=0.327) also were comparable between groups. The rates of death (6.3% vs 2.5%, р=0.001), MACEs (7.6% vs 4.1%, р=0.008), and no-reflow (6.9% vs 3.6%, р=0,009) were significantly higher in patients with high level of blood glycemia (>7.52 mmol/l). Angiographic success rate (95.1% vs 92.1%, р=0.029) was higher in patients with low level of glycemia (≤7.52 mmol/l). After multivariate adjustment, high level of blood glycemia (>7.52 mmol/l) remained an independent predictor of death (OR=2.28; 95% CI 1.18-4.40, р=0.014), MACE (OR=2.08; 95% CI 1.16-3.75, р=0.014) and no-reflow (OR=2.07; 95% CI 1.15-3.74, р=0.015). At the same time DM wasn't associated with death, MACE or no-reflow.

CONCLUSION

High level of blood glycemia was an independent predictor of death, MACE and no-reflow in patients with STEMI, undergoing PCI. The presence of DM was not associated with worse in-hospital outcomes.

摘要

未标注

本研究的目的是评估糖尿病（DM）和血糖水平对接受经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者治疗结果的影响。

材料与方法

收集2006年至2015年入住冠心病监护病房并接受PCI的所有STEMI患者（n = 1280）的数据。将212例（16.6%）糖尿病患者与1068例（83.4%）非糖尿病患者（非DM组）进行比较。为研究血糖水平的影响，将所有患者分为血糖中位数（7.5２ mmol/l）以上和以下两组。

结果

因此，将634例高血糖水平（>7.52 mmol/l）患者与635例低血糖水平（≤7.52 mmol/l）患者进行比较。在DM组和非DM组的比较中，死亡率（5.2%对4.2%，p = 0.526）、支架血栓形成率（1.4%对1.0%，p = 0.622）、再发性心肌梗死（MI）（1.4%对1.2%，p = 0.813）和主要不良心脏事件（MACE）（7.5%对5.4%，p = 0.228，包括住院死亡、再发性MI和支架血栓形成）方面无差异。两组间血管造影成功率（92.9%对93.8%，p = 0.625）和无复流发生率（6.6%对5%，p = 0.327）也相当。高血糖水平（>7.52 mmol/l）患者的死亡率（6.3%对2.5%，p =　0.001）、MACE发生率（7.6%对4.1%，p = 0.008）和无复流发生率（6.9%对3.6%，p = 0.009）显著更高。低血糖水平（≤7.52 mmol/l）患者的血管造影成功率（95.1%对92.1%，p = 0.029）更高。多因素调整后，高血糖水平（>7.52 mmol/l）仍然是死亡（OR = 2.28；95%CI 1.18 - 4.40，p = 0.014）、MACE（OR = 2.08；95%CI 1.16 - 3.75，p = 0.014）和无复流（OR = 2.07；95%CI 1.15 - 3.74，p = 0.015）的独立预测因素。同时，DM与死亡、MACE或无复流无关。