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[糖化血红蛋白和血糖对心肌梗死后非糖尿病患者一年死亡率的预后价值]

[Prognostic value of HbA1c and plasma glucose on one-year mortality in non-diabetic patients after myocardial infarction].

作者信息

Gueniat-Ratheau E, Yao H, Debeaumarche H, Maalem B, Lairet C, Maza M, Bichat F, Zeller M, N'Guetta R, Cottin Y

机构信息

Cardiology department, CHU de Dijon, Dijon, France.

Cardiology department, institut de cardiologie, 01 BP V 2062, Abidjan, Côte d'Ivoire.

出版信息

Ann Cardiol Angeiol (Paris). 2020 Oct;69(4):180-191. doi: 10.1016/j.ancard.2020.03.020. Epub 2020 Aug 24.


DOI:10.1016/j.ancard.2020.03.020
PMID:32854906
Abstract

BACKGROUND: The usefulness of the combined assessment of HbA1c and plasma glucose (PG) in acute myocardial infarction (AMI) in non-diabetic patients remains unclear. PURPOSE: In a large observational study, we aimed to identify the prognostic values of these biomarkers regarding one-year all-cause mortality in non-diabetic patients after AMI. METHODS: From the "obseRvatoire des Infarctus de Côte d'Or" (RICO) survey database, we included all consecutive non-diabetic patients with AMI (n=6617) from May 2001 to December 2016. Exclusion criteria were: admission known or unknown diabetes, in-hospital death. The primary endpoint was all-cause one-year mortality. The secondary endpoints were: MACE, infarct size, LVEF<40% and GRACE risk score. Cut-off levels (high/low) were determined by ROC curve analysis for the prediction of one-year death (HbA1c 5.9% and PG 131mg/dL) to set up 4 groups: low HbA1c/low glucose (n=3158), low HbA1c/high glucose (n=1264), high HbA1c/low glucose (n=1378) and high HbA1c/high glucose (n=817). RESULTS: Elevation of PG was associated with elevated rate of LVEF<40%, STEMI, anterior wall location, DFG<60mL/min/m and higher troponin Ic pic (all P<0.001); HbA1c>5.9% was associated with elevated rate of CRP>3mg/L (P<0.001); high HbA1c and high PG together were associated with higher rate of MACE (P<0.001). By multivariate logistic regression analysis, elevated admission PG remained a strong predictor of one-year all-cause [OR (95%CI): 1.64 (1.31-2.05)] mortality and cardiovascular mortality [OR (95%CI): 1.75 (1.33-2.31)], beyond GRACE score [OR (95%CI): 1.03 (1.03-1.04)], as well as elevated HbA1c [OR (95%CI): 1.43 (1.15-1.78) and OR (95%CI): 1.83 (1.39-2.41) respectively]. CONCLUSIONS: Admission PG and HbA1c had strong independent predictive value regarding one-year all-cause mortality in our non-diabetic patients with AMI. These biomarkers could be useful to identify the most-at-risk patients after AMI in order to reduce residual risk in this target population.

摘要

背景:糖化血红蛋白(HbA1c)与血糖(PG)联合评估在非糖尿病患者急性心肌梗死(AMI)中的作用尚不清楚。 目的:在一项大型观察性研究中,我们旨在确定这些生物标志物对非糖尿病患者AMI后一年全因死亡率的预后价值。 方法:从“科多尔省心肌梗死观察研究”(RICO)调查数据库中,我们纳入了2001年5月至2016年12月期间所有连续的非糖尿病AMI患者(n = 6617)。排除标准为:入院时已知或未知糖尿病、院内死亡。主要终点是一年全因死亡率。次要终点为:主要不良心血管事件(MACE)、梗死面积、左心室射血分数(LVEF)<40%以及全球急性冠状动脉事件注册(GRACE)风险评分。通过ROC曲线分析确定预测一年死亡的截断水平(高/低)(HbA1c为5.9%,PG为131mg/dL),以建立4组:低HbA1c/低血糖(n = 3158)、低HbA1c/高血糖(n = 1264)、高HbA1c/低血糖(n = 1378)和高HbA1c/高血糖(n = 817)。 结果:PG升高与LVEF<40%、ST段抬高型心肌梗死(STEMI)、前壁位置、估算肾小球滤过率(DFG)<60mL/min/m²以及肌钙蛋白Ic峰值升高的发生率升高相关(均P<0.001);HbA1c>5.9%与C反应蛋白(CRP)>3mg/L的发生率升高相关(P<0.001);高HbA1c和高PG共同与MACE发生率升高相关(P<0.001)。通过多因素逻辑回归分析,入院时PG升高仍然是一年全因死亡率[比值比(95%置信区间):1.64(1.31 - 2.05)]和心血管死亡率[比值比(95%置信区间):1.75(1.33 - 2.31)]的强预测因素,超过GRACE评分[比值比(95%置信区间):1.03(1.03 - 1.04)],以及HbA1c升高[分别为比值比(95%置信区间):1.43(1.15 - 1.78)和比值比(95%置信区间):1.83(1.39 - 2.41)]。 结论:入院时PG和HbA1c对我们的非糖尿病AMI患者一年全因死亡率具有强大的独立预测价值。这些生物标志物有助于识别AMI后风险最高的患者,以降低该目标人群的残余风险。

相似文献

[1]
[Prognostic value of HbA1c and plasma glucose on one-year mortality in non-diabetic patients after myocardial infarction].

Ann Cardiol Angeiol (Paris). 2020-10

[2]
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Cardiovasc Diabetol. 2021-10-19

[3]
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J Am Heart Assoc. 2020-2-26

[4]
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[5]
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[6]
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Eur Rev Med Pharmacol Sci. 2013-5

[7]
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