Shitole Sanyog G, Srinivas Vankeepuram, Berkowitz Julia L, Shah Tina, Park Michael J, Herzig Samuel, Christian Anne, Patel Neeral, Xue Xiaonan, Scheuer James, Kizer Jorge R
San Francisco Veterans Affairs Health Care System and University of California San Francisco San Francisco CA USA.
Montefiore Health System Bronx NY USA.
Endocrinol Diabetes Metab. 2019 Aug 14;3(1):e00089. doi: 10.1002/edm2.89. eCollection 2020 Jan.
Hyperglycaemia occurs frequently in ST-elevation myocardial infarction (STEMI) and is associated with poor outcomes, for which continuous insulin infusion therapy (CIIT) may be beneficial. Information is limited regarding hyperglycaemia in acute STEMI affecting urban minority populations, or how CIIT fares in such real-world settings.
We assembled an acute STEMI registry at an inner-city health system, focusing on patients with initial blood glucose ≥180 mg/dL to determine the impact of CIIT vs usual care. Clinical and outcomes data were added through linkage to electronic records. Inverse-probability-of-treatment weighting using propensity scores (PS) was used to compare CIIT vs no CIIT. The 1067 patients included were mostly Hispanic or African American; 356 had blood glucose ≥180 mg/dL. Such pronounced hyperglycaemia was related to female sex, minority race-ethnicity and lower socioeconomic score, and associated with increased death and death or CVD readmission. CIIT was preferentially used in patients with marked hyperglycaemia and was associated with in-hospital hypoglycaemia (21% vs 11%, = .019) and, after PS weighting, with increased in-hospital (RR 3.23, 95% CI 0.94, 11.06) and 1-year (RR 2.26, 95% CI 1.02, 4.98) mortality. No significant differences were observed for death at 30 days or throughout follow-up, or death and readmission at any time point.
Pronounced hyperglycaemia was common and associated with adverse prognosis in this urban population. CIIT met with selective use and was associated with hypoglycaemia, together with increased mortality at specific time points. Given the burden of metabolic disease, particularly among race-ethnic minorities, assessing the benefits of CIIT is a prerogative that requires evaluation in large-scale randomized trials.
高血糖在ST段抬高型心肌梗死（STEMI）中频繁出现，且与不良预后相关，对此持续胰岛素输注治疗（CIIT）可能有益。关于影响城市少数族裔人群的急性STEMI中的高血糖情况，或CIIT在这种现实环境中的效果，相关信息有限。
我们在一个市中心卫生系统建立了急性STEMI登记处，重点关注初始血糖≥180mg/dL的患者，以确定CIIT与常规治疗的效果。通过与电子记录联动添加临床和结局数据。使用倾向评分（PS）进行治疗逆概率加权，以比较CIIT与未接受CIIT的情况。纳入的1067例患者大多为西班牙裔或非裔美国人；356例血糖≥180mg/dL。这种明显的高血糖与女性、少数族裔和较低的社会经济得分有关，并与死亡及死亡或心血管疾病再入院风险增加相关。CIIT优先用于明显高血糖的患者，且与院内低血糖相关（21%对11%，P = 0.019），在PS加权后，与院内死亡率增加（风险比[RR] 3.23，95%置信区间[CI] 0.94，11.06）和1年死亡率增加（RR 2.26，95% CI 1.02，4.98）相关。在30天或整个随访期间的死亡，或任何时间点的死亡及再入院方面，未观察到显著差异。
在这个城市人群中，明显的高血糖很常见且与不良预后相关。CIIT使用具有选择性，与低血糖相关，同时在特定时间点死亡率增加。鉴于代谢性疾病的负担，特别是在少数族裔中，评估CIIT的益处是一项需要在大规模随机试验中进行评估的特权。
