心肌梗死后新诊断的糖尿病前期会对无已知糖尿病的患者的预后产生不利影响。

Pre-diabetes mellitus newly diagnosed after myocardial infarction adversely affects prognosis in patients without known diabetes.

机构信息

Department of Cardiology, Milton Keynes University Hospital, Milton Keynes, UK.

Department of Cardiology, Scunthorpe General Hospital, Scunthorpe, UK.

出版信息

Diab Vasc Dis Res. 2019 Nov;16(6):489-497. doi: 10.1177/1479164119845561. Epub 2019 May 2.

DOI:10.1177/1479164119845561

PMID:31044609

Abstract

BACKGROUND

Effect of pre-diabetes mellitus on post-myocardial infarction prognosis is unclear.

METHODS

Retrospective cohort analysis of 1056 myocardial infarction survivors with fasting plasma glucose and 2-h post-load plasma glucose measured. Major adverse cardiovascular events included death, non-fatal reinfarction and ischaemic stroke. Cox proportional hazard regression identified predictors of event-free survival. Continuous net reclassification improvement and integrated discrimination improvement determined the added predictive value of glycaemic indices.

RESULTS

Major adverse cardiovascular events occurred in 25.1% and 16.4% patients with and without pre-diabetes mellitus (hazard ratio with pre-diabetes mellitus: 1.56; 95% confidence interval: 1.17-2.08; = 0.003) in the whole cohort and in 24.1% and 17.2% patients (hazard ratio with pre-diabetes mellitus, 1.43; 95% confidence interval: 1.03-1.98; = 0.033) in the matched cohort, respectively. Pre-diabetes mellitus predicted major adverse cardiovascular events-free survival in whole (hazard ratio: 1.39; 95% confidence interval: 1.03-1.89; = 0.033) and matched cohorts (hazard ratio: 1.42; 95% confidence interval: 1.01-1.99; = 0.043). The 2-h post-load plasma glucose, but not fasting plasma glucose, predicted major adverse cardiovascular events-free survival in the whole (hazard ratio: 1.16; 95% confidence interval: 1.07-1.26; < 0.0001) and matched cohorts (hazard ratio: 1.20; 95% confidence interval: 1.09-1.31; < 0.0001). Adding 2-h post-load plasma glucose to models containing fasting plasma glucose, significantly improved net reclassification improvement and integrated discrimination improvement for both cohorts, but not vice versa.

CONCLUSION

Pre-diabetes mellitus predicts major adverse cardiovascular events after myocardial infarction. The 2-h post-load plasma glucose predicts prognosis better than fasting plasma glucose in these patients.

摘要

背景

糖尿病前期对心肌梗死后的预后影响尚不清楚。

方法

回顾性分析了 1056 例心肌梗死后幸存者的空腹血糖和 2 小时餐后血糖。主要不良心血管事件包括死亡、非致死性再梗死和缺血性卒中。Cox 比例风险回归确定了无事件生存的预测因素。连续净重新分类改善和综合鉴别改善确定了血糖指数的附加预测价值。

结果

在整个队列中，有和没有糖尿病前期的患者主要不良心血管事件的发生率分别为 25.1%和 16.4%（糖尿病前期患者的风险比：1.56；95%置信区间：1.17-2.08； = 0.003），在匹配队列中分别为 24.1%和 17.2%（糖尿病前期患者的风险比：1.43；95%置信区间：1.03-1.98； = 0.033）。糖尿病前期可预测整个队列（风险比：1.39；95%置信区间：1.03-1.89； = 0.033）和匹配队列（风险比：1.42；95%置信区间：1.01-1.99； = 0.043）的主要不良心血管事件无事件生存。在整个队列中，2 小时餐后血糖（风险比：1.16；95%置信区间：1.07-1.26； < 0.0001）和匹配队列（风险比：1.20；95%置信区间：1.09-1.31； < 0.0001）中，均可预测主要不良心血管事件无事件生存，但空腹血糖不能预测。将 2 小时餐后血糖加入包含空腹血糖的模型中，可显著提高两个队列的净重新分类改善和综合鉴别改善，但反之则不然。