隐匿性糖尿病和糖尿病前期对中国“非糖尿病”患者首次冠状动脉介入治疗后临床结局的影响。

Impact of unknown diabetes and prediabetes on clinical outcomes in "nondiabetic" Chinese patients after a primary coronary intervention.

作者信息

Wang Huanhuan, Song Ying, Tang Xiaofang, Xu Jingjing, Jiang Ping, Jiang Lin, Gao Zhan, Chen Jue, Song Lei, Zhang Yin, Zhao Xueyan, Qiao Shubin, Yang Yuejin, Gao Runlin, Xu Bo, Yuan Jinqing, Gao Lijian

机构信息

Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.

出版信息

Nutr Metab Cardiovasc Dis. 2020 Apr 12;30(4):644-651. doi: 10.1016/j.numecd.2019.11.013. Epub 2019 Dec 3.

DOI:10.1016/j.numecd.2019.11.013

PMID:32143897

Abstract

BACKGROUND AND AIM

To explore the prevalence of unknown diabetes (DM) or prediabetes (pre-DM) in "nondiabetic" patients and its association with 2-year clinical outcomes after primary percutaneous coronary intervention (PCI).

METHODS AND RESULTS

5202 consecutive "nondiabetic" patients who underwent primary PCI at Fuwai Hospital from January to December 2013 were prospectively enrolled. The patients were grouped according to their glycemia status: unknown DM (HbA1c ≥ 47 mmol/L; FPG≥ 7.0 mmol/L), pre-DM (HbA1c 39-47 mmol/L; FPG: 5.6-6.9 mmol/L) and normoglycemia (NG, HbA1c < 39 mmol/L; FPG < 5.6 mmol/L). The main endpoint was 2-year major adverse cardiovascular events (MACE), including cardiac death, myocardial infarction, and target vessel revascularization. A total of 905 patients had unknown DM, and 3407 patients had pre-DM. Unknown DM and pre-DM were associated with aging (p < 0.001); a greater proportion of hypertension (p < 0.001), previous myocardial infarction (p < 0.001), and chronic kidney disease (p = 0.004). During the 2-year follow-up, the rate of MACE was significantly higher in the unknown DM and pre-DM groups than in the NG group (8.1% vs. 5.8% vs. 4.1%, respectively, p = 0.001). Multivariate analyses demonstrated that unknown DM was associated with a 1.9-fold higher event risk compared to NG (95% CI: 1.2-2.8).

CONCLUSIONS

The prevalence of abnormal glucose metabolism was high in "nondiabetic" Chinese PCI patients. Patients with unknown DM and pre-DM had higher event risks than those with NG. In "nondiabetes" patients requiring PCI, routine assessment of HbA1c and FPG appears to be of value to identify patients with an increased event risk.

摘要

背景与目的

探讨“非糖尿病”患者中未确诊糖尿病（DM）或糖尿病前期（pre-DM）的患病率及其与初次经皮冠状动脉介入治疗（PCI）后2年临床结局的关联。

方法与结果

前瞻性纳入2013年1月至12月在阜外医院接受初次PCI的5202例连续“非糖尿病”患者。根据血糖状态将患者分组：未确诊DM（糖化血红蛋白[HbA1c]≥47 mmol/L；空腹血糖[FPG]≥7.0 mmol/L）、pre-DM（HbA1c 39 - 47 mmol/L；FPG：5.6 - 6.9 mmol/L）和血糖正常（NG，HbA1c < 39 mmol/L；FPG < 5.6 mmol/L）。主要终点为2年主要不良心血管事件（MACE），包括心源性死亡、心肌梗死和靶血管血运重建。共有905例患者未确诊DM，3407例患者为pre-DM。未确诊DM和pre-DM与衰老相关（p < 0.001）；高血压（p < 0.001）、既往心肌梗死（p < 0.001）和慢性肾脏病（p = 0.004）的比例更高。在2年随访期间，未确诊DM组和pre-DM组的MACE发生率显著高于NG组（分别为8.1%、5.8%和4.1%，p = 0.001）。多变量分析表明，与NG相比，未确诊DM的事件风险高1.9倍（95%置信区间：1.2 - 2.8）。