Department of Cardiology, Isala, The Netherlands.
Department of Internal Medicine, Isala, The Netherlands.
Eur Heart J Acute Cardiovasc Care. 2020 Sep;9(6):616-625. doi: 10.1177/2048872619849921. Epub 2019 May 24.
Long-term clinical outcome is less well known in up to presentation persons unknown with diabetes mellitus who present with acute myocardial infarction and elevated glycosylated haemoglobin (HbA1c) levels on admission. We aimed to study the prognostic impact of deranged HbA1c at presentation on long-term mortality in patients not known with diabetes, presenting with acute myocardial infarction.
A single-centre, large, prospective observational study in patients with and without known diabetes admitted to our hospital for ST-segment elevation myocardial infarction (STEMI) and non-STEMI. Newly diagnosed diabetes mellitus was defined as HbA1c of 48 mmol/l or greater and pre-diabetes mellitus was defined as HbA1c between 39 and 47 mmol/l. The primary endpoint was all-cause mortality at short (30 days) and long-term (median 52 months) follow-up.
Out of 7900 acute myocardial infarction patients studied, 1314 patients (17%) were known diabetes patients. Of the 6586 patients without known diabetes, 3977 (60%) had no diabetes, 2259 (34%) had pre-diabetes and 350 (5%) had newly diagnosed diabetes based on HbA1c on admission. Both short-term (3.9% vs. 7.4% vs. 6.0%, p0.001) and long-term mortality (19% vs. 26% vs. 35%, p0.001) for both pre-diabetes patients as well as newly diagnosed diabetes patients was poor and comparable to known diabetes patients. After multivariate analysis, newly diagnosed diabetes was independently associated with long-term mortality (hazard ratio 1.72, 95% confidence interval 1.27-2.34, =0.001).
In the largest study to date, newly diagnosed or pre-diabetes was present in 33% of acute myocardial infarction patients and was associated with poor long-term clinical outcome. Newly diagnosed diabetes (HbA1c ⩾48 mmol/mol) is an independent predictor of long-term mortality. More attention to early detection of diabetic status and initiation of blood glucose-lowering treatment is necessary.
对于因急性心肌梗死入院且糖化血红蛋白（HbA1c）升高的不明原因糖尿病患者，目前尚不清楚其长期临床结局。我们旨在研究入院时 HbA1c 异常对非已知糖尿病患者急性心肌梗死长期死亡率的预后影响。
这是一项在因 ST 段抬高型心肌梗死（STEMI）和非 ST 段抬高型心肌梗死而入住我院的有或无已知糖尿病的患者中进行的单中心、大型、前瞻性观察性研究。新诊断的糖尿病定义为 HbA1c 大于等于 48mmol/L，糖尿病前期定义为 HbA1c 在 39 至 47mmol/L 之间。主要终点是短期（30 天）和长期（中位时间为 52 个月）随访时的全因死亡率。
在研究的 7900 例急性心肌梗死患者中，1314 例（17%）为已知糖尿病患者。在 6586 例无已知糖尿病的患者中，3977 例（60%）无糖尿病，2259 例（34%）为糖尿病前期，350 例（5%）根据入院时的 HbA1c 诊断为新发糖尿病。新发糖尿病患者的短期（3.9%比 7.4%比 6.0%，p<0.001）和长期死亡率（19%比 26%比 35%，p<0.001）均较差，与已知糖尿病患者相当。多变量分析后，新发糖尿病与长期死亡率独立相关（危险比 1.72，95%置信区间 1.27-2.34，p=0.001）。
在迄今为止最大的研究中，33%的急性心肌梗死患者存在新发或糖尿病前期，且与长期临床结局不良相关。新发糖尿病（HbA1c≥48mmol/mol）是长期死亡率的独立预测因素。需要更加重视早期发现糖尿病状态并开始降血糖治疗。
