Gueniat-Ratheau E, Yao H, Debeaumarche H, Maalem B, Lairet C, Maza M, Bichat F, Zeller M, N'Guetta R, Cottin Y
Cardiology department, CHU de Dijon, Dijon, France.
Cardiology department, institut de cardiologie, 01 BP V 2062, Abidjan, Côte d'Ivoire.
Ann Cardiol Angeiol (Paris). 2020 Oct;69(4):180-191. doi: 10.1016/j.ancard.2020.03.020. Epub 2020 Aug 24.
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.
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。
Ann Cardiol Angeiol (Paris). 2020-10
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