Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden.
Department of Research and Development, Region Kronoberg, Växjö, Sweden.
Diab Vasc Dis Res. 2019 Nov;16(6):582-584. doi: 10.1177/1479164119871540. Epub 2019 Sep 3.
To investigate the association between admission plasma glucose and cardiovascular events in patients with acute myocardial infarction treated with modern therapies including early percutaneous coronary intervention and modern stents.
Patients ( = 5309) with established diabetes and patients without previously known diabetes with a reported admission plasma glucose, included in the VALIDATE trial 2014-2016, were followed for cardiovascular events (first of mortality, myocardial infarction, stroke, heart failure) within 180 days. Event rates were analysed by four glucose categories according to the World Health Organization criteria for hyperglycaemia and definition of diabetes. Odds ratios were calculated in a multivariate logistic regression model.
Mean age was 67 ± 11 years. Previously known diabetes was present in 21.2% ( = 1124). Cardiovascular events occurred in 3.7%, 3.8%, 6.6% and 15.7% in the four glucose level groups and 9.9% in those with known diabetes ( < 0.001), while bleeding complications did not differ significantly (9.1%, 8.5%, 8.4%, 12.2% and 8.5%, respectively). After adjustment, odds ratio (95% confidence interval) was 1.00 (0.65-1.53) for group II, 1.62 (1.14-2.29) for group III and 3.59 (1.99-6.50) for group IV compared to the lowest admission plasma glucose group (group I). The corresponding number for known diabetes was 2.42 (1.71-3.42).
In a well-treated contemporary population of acute myocardial infarction patients, 42% of those without diabetes had elevated admission plasma glucose levels with a greater risk for clinical events already within 180 days. Event rate increased with increasing admission plasma glucose levels. These findings highlight the importance of searching for undetected diabetes in the setting of acute myocardial infarction and that new treatment options are needed to improve outcome.
研究在接受包括早期经皮冠状动脉介入治疗和现代支架在内的现代治疗的急性心肌梗死患者中，入院时血糖与心血管事件的关系。
纳入 2014-2016 年VALIDATE 试验中已确诊糖尿病的患者和未确诊糖尿病但报告入院时血糖的患者，随访 180 天内的心血管事件（死亡率、心肌梗死、卒中和心力衰竭的首次发生）。根据世界卫生组织高血糖标准和糖尿病定义，将血糖分为四个类别进行分析。采用多变量逻辑回归模型计算比值比。
平均年龄为 67 ± 11 岁。已知糖尿病患者占 21.2%（n = 1124）。四个血糖水平组的心血管事件发生率分别为 3.7%、3.8%、6.6%和 15.7%，已知糖尿病患者为 9.9%（<0.001），而出血并发症无显著差异（分别为 9.1%、8.5%、8.4%和 12.2%）。调整后，与最低入院时血糖组（组 I）相比，组 II 的比值比（95%置信区间）为 1.00（0.65-1.53），组 III 为 1.62（1.14-2.29），组 IV 为 3.59（1.99-6.50）。已知糖尿病的相应数值为 2.42（1.71-3.42）。
在治疗良好的当代急性心肌梗死患者人群中，42%无糖尿病患者的入院时血糖水平升高，180 天内发生临床事件的风险更高。随着入院时血糖水平的升高，事件发生率也随之增加。这些发现强调了在急性心肌梗死患者中寻找未确诊糖尿病的重要性，并且需要新的治疗选择来改善预后。
