Cardiology Department, Ingham Institute at Liverpool Hospital, Sydney, Australia; The University of New South Wales, Sydney, Australia; Cardiology Department, Nepean Hospital, Sydney, Australia.
Cardiology Department, Ingham Institute at Liverpool Hospital, Sydney, Australia; The University of New South Wales, Sydney, Australia.
Int J Cardiol. 2021 Jan 15;323:13-18. doi: 10.1016/j.ijcard.2020.08.021. Epub 2020 Aug 14.
In patients with diabetes mellitus presenting with ST elevation myocardial infarction (STEMI) the degree to which cardiac death rates may be attributed to an increased burden of coronary artery disease is not clear.
This prospective observational study examines rates of cardiac death between those with and without diabetes at long term follow up, stratified by presence of multivessel disease (MVD), in consecutive STEMI patients from 5 Australian hospitals.
Amongst 2083 patients, 393 patients had diabetes (18.8%), and 810 (38.8%) had MVD. Patients with diabetes were more likely to have MVD 48.6% (191/393) than patients without diabetes 36.6% (619/1690; p < .001). At final follow up (median 3.6 years [IQR 2.4-5.4]) cardiac death occurred in 37/393 diabetic patients and 92/1690 nondiabetic patients (adjusted HR1.67, 95% CI 1.10-2.52). In those with MVD cardiac death occurred in 27/191 diabetic patients, and 54/619 non-diabetic patients (adjusted HR 1.94; 95% CI 1.17-3.23). In single vessel disease (SVD) cardiac death occurred in 10/202 diabetic patients, and 38/1071 non-diabetic patients (adjusted HR 1.37; 95% CI 0.65-2.89). Both diabetes and MVD were independently associated with cardiac death.
STEMI patients with diabetes are more likely to have MVD, with an absolute difference in MVD rates of 12%, and higher rates of cardiac death. Randomized trials studying these high risk patients are needed to reduce cardiac mortality in patients with diabetes, MVD and STEMI.
患有 ST 段抬高型心肌梗死（STEMI）的糖尿病患者，其心脏死亡率归因于冠状动脉疾病负担增加的程度尚不清楚。
本前瞻性观察研究在来自澳大利亚 5 家医院的连续 STEMI 患者中，根据多血管疾病（MVD）的存在情况，在长期随访时比较有和无糖尿病患者之间的心脏死亡率，并对这些患者进行分层分析。
在 2083 例患者中，393 例患有糖尿病（18.8%），810 例（38.8%）患有 MVD。患有糖尿病的患者更有可能患有 MVD（48.6%，191/393），而非糖尿病患者（36.6%，619/1690；p<0.001）。在最终随访（中位数 3.6 年[IQR 2.4-5.4]）时，393 例糖尿病患者中有 37 例发生心脏死亡，1690 例非糖尿病患者中有 92 例发生心脏死亡（校正 HR1.67，95%CI 1.10-2.52）。在患有 MVD 的患者中，27 例糖尿病患者和 54 例非糖尿病患者发生心脏死亡（校正 HR 1.94；95%CI 1.17-3.23）。在单支血管疾病（SVD）患者中，10 例糖尿病患者和 38 例非糖尿病患者发生心脏死亡（校正 HR 1.37；95%CI 0.65-2.89）。糖尿病和 MVD 均与心脏死亡独立相关。
患有糖尿病的 STEMI 患者更有可能患有 MVD，其 MVD 发生率的绝对差异为 12%，并且心脏死亡率更高。需要进行随机试验来研究这些高危患者，以降低糖尿病、MVD 和 STEMI 患者的心脏死亡率。
