Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Diab Vasc Dis Res. 2020 Jul-Aug;17(4):1479164120941809. doi: 10.1177/1479164120941809.
Diabetes is considered a risk factor for myocardial infarction. However, we have previously found that diabetes was not a short-term risk factor for myocardial infarction in the absence of obstructive coronary artery disease.
We conducted a cohort study of patients undergoing coronary angiography from 2003 to 2012 and followed them by cross-linking Danish health registries. Patients were stratified according to coronary artery disease and diabetes. Endpoints included myocardial infarction, cardiac death, all-cause death and coronary revascularization.
86,202 patients were included in total (diabetes: = 12,652). Median follow-up was 8.8 years. Using patients with neither coronary artery disease nor diabetes as reference (cumulative myocardial infarction incidence 2.6%), the risk of myocardial infarction was low and not substantially increased for patients with diabetes alone (3.2%; hazard ratio 1.202, 95% confidence interval 0.996-1.451), was increased for patients with coronary artery disease alone (9.3%; hazard ratio 2.75, 95% confidence interval 2.52-3.01) and was highest for patients with both coronary artery disease and diabetes (12.3%; hazard ratio 3.79, 95% confidence interval 3.43-4.20). Similar associations were observed for cardiac death and coronary revascularization.
Diabetes patients without coronary artery disease by coronary angiography have a low risk of myocardial infarction, not substantially increased compared to patients with neither coronary artery disease nor diabetes. In the presence of coronary artery disease, however, diabetes increases the risk of myocardial infarction.
糖尿病被认为是心肌梗死的一个危险因素。然而，我们之前发现，在没有阻塞性冠状动脉疾病的情况下，糖尿病不是心肌梗死的短期危险因素。
我们对 2003 年至 2012 年接受冠状动脉造影的患者进行了队列研究，并通过交联丹麦健康登记处对其进行了随访。根据冠状动脉疾病和糖尿病对患者进行分层。终点包括心肌梗死、心脏死亡、全因死亡和冠状动脉血运重建。
共纳入 86202 例患者（糖尿病：12652 例）。中位随访时间为 8.8 年。以既无冠状动脉疾病也无糖尿病的患者为参照（累积心肌梗死发生率为 2.6%），患有糖尿病的患者的心肌梗死风险较低，且并未显著增加（3.2%；风险比 1.202，95%置信区间 0.996-1.451），仅患有冠状动脉疾病的患者风险增加（9.3%；风险比 2.75，95%置信区间 2.52-3.01），同时患有冠状动脉疾病和糖尿病的患者风险最高（12.3%；风险比 3.79，95%置信区间 3.43-4.20）。对于心脏死亡和冠状动脉血运重建，也观察到类似的关联。
经冠状动脉造影无冠状动脉疾病的糖尿病患者发生心肌梗死的风险较低，与既无冠状动脉疾病也无糖尿病的患者相比，风险无明显增加。然而，在存在冠状动脉疾病的情况下，糖尿病会增加心肌梗死的风险。
