Department of Internal Medicine, Section of Endocrinology and Diabetes, Bolzano General Hospital, Bolzano, Italy.
Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Clinical Sciences and Community Health Università degli Studi di Milano, Milan, Italy.
Am J Med. 2020 Mar;133(3):331-339.e2. doi: 10.1016/j.amjmed.2019.07.044. Epub 2019 Aug 22.
Our study was intended to examine time trends of management and mortality of acute coronary syndrome patients with associated diabetes mellitus.
We analyzed data from 5 nationwide registries established between 2001 and 2014, including consecutive acute coronary syndrome patients admitted to the Italian Intensive Cardiac Care Units.
Of 28,225 participants, 8521 (30.2%) had diabetes: as compared with patients without diabetes, they were older and had significantly higher rates of prior myocardial infarction and comorbidities (all P < .0001). Prevalence of diabetes and comorbidities increased over time (P for trend < .0001). Cardiogenic shock rates were higher in patients with diabetes, as compared with those without diabetes (7.8% vs 2.8%, P < .0001), and decreased significantly over time only in patients without diabetes (P = .007). Revascularization rates increased over time in patients both with and without diabetes (both P for trend < .0001), although with persistingly lower rates in patients with diabetes. All-cause in-hospital mortality was higher in patients with diabetes (5.4 vs 2.5%, respectively, P < .0001) and decreased more consistently in patients without diabetes (P for trend = .007 and < .0001, respectively). At multivariable analysis, diabetes remains an independent predictor of both cardiogenic shock (odds ratio 2.03; 95% confidence interval, 1.77-2.32; P < .0001) and mortality (odds ratio 1.95; 95% confidence interval, 1.69-2.26; P < .0001).
Despite significant mortality reductions observed over 15 years in acute coronary syndromes, patients with diabetes continue to show threefold higher rates of cardiogenic shock and lower revascularization rates as compared with patients without diabetes. These findings may explain the persistingly higher mortality of patients with diabetes and acute coronary syndromes.
本研究旨在探讨合并糖尿病的急性冠状动脉综合征患者的管理和死亡率的时间趋势。
我们分析了 2001 年至 2014 年间建立的 5 个全国性登记处的数据，包括意大利重症监护心脏病房收治的连续急性冠状动脉综合征患者。
在 28225 名参与者中，8521 名（30.2%）患有糖尿病：与无糖尿病患者相比，他们年龄更大，且先前心肌梗死和合并症的发生率明显更高（均 P<0.0001）。糖尿病和合并症的患病率随时间推移而增加（趋势 P<0.0001）。与无糖尿病患者相比，糖尿病患者的心源性休克发生率更高（7.8%比 2.8%，P<0.0001），且仅在无糖尿病患者中随时间推移显著下降（P=0.007）。在有或没有糖尿病的患者中，血运重建率随时间推移而增加（两者的趋势 P<0.0001），但糖尿病患者的血运重建率仍较低。糖尿病患者的院内全因死亡率更高（分别为 5.4%和 2.5%，P<0.0001），且在无糖尿病患者中死亡率下降更为一致（趋势 P=0.007 和<0.0001）。多变量分析显示，糖尿病仍然是心源性休克（优势比 2.03；95%置信区间，1.77-2.32；P<0.0001）和死亡率（优势比 1.95；95%置信区间，1.69-2.26；P<0.0001）的独立预测因素。
尽管在过去 15 年中观察到急性冠状动脉综合征的死亡率显著下降，但与无糖尿病患者相比，糖尿病患者的心源性休克发生率仍高出三倍，血运重建率更低。这些发现可能解释了急性冠状动脉综合征合并糖尿病患者的死亡率持续较高的原因。
