Kim Yong Hoon, Her Ae-Young, Jeong Myung Ho, Kim Byeong-Keuk, Hong Sung-Jin, Kim Seunghwan, Ahn Chul-Min, Kim Jung-Sun, Ko Young-Guk, Choi Donghoon, Hong Myeong-Ki, Jang Yangsoo
Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon 24341, Korea.
Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju 61469, Korea.
J Clin Med. 2020 Oct 27;9(11):3447. doi: 10.3390/jcm9113447.
Long-term clinical outcomes in patients with acute myocardial infarction (AMI) and prediabetes or diabetes who received ß-blockers (BB) and renin-angiotensin system inhibitor (RASI) therapy after successful newer-generation drug-eluting stent (DES) implantation are limited. We compared the two-year clinical outcomes in such patients. A total of 9466 patients with AMI in the Korea AMI Registry were classified into six groups according to their glycemic status and presence or absence of BB + RASI therapy: normoglycemia and BB + RASI users ( = 2217) or nonusers ( = 243), prediabetes and BB + RASI users ( = 2601) or nonusers ( = 306), and diabetes and BB + RASI users ( = 3682) or nonusers ( = 417). The primary endpoint was major adverse cardiac events (MACEs) defined as all-cause death, recurrent myocardial infarction (Re-MI), or any repeat revascularization, and the secondary endpoint was the cumulative incidence of hospitalization for heart failure (HHF). In patients with BB + RASI, despite similar primary and secondary clinical points between the prediabetes and diabetes groups, the cumulative incidence of Re-MI (adjusted hazard ratio: 1.660; 95% confidence interval: 1.000-2.755; = 0.020) was higher in the diabetes group than in the prediabetes group. In all three different glycemic groups, BB + RASI users showed reduced MACEs, cardiac death, and HHF compared to those of BB + RASI nonusers. In this retrospective observational registry study, BB + RASI therapy showed comparable clinical outcomes except for Re-MI between prediabetes and diabetes in patients with AMI during a two-year follow-up period.
急性心肌梗死（AMI）合并糖尿病前期或糖尿病患者在新一代药物洗脱支架（DES）成功植入后接受β受体阻滞剂（BB）和肾素-血管紧张素系统抑制剂（RASI）治疗的长期临床结局有限。我们比较了此类患者的两年临床结局。韩国AMI注册研究中共有9466例AMI患者根据其血糖状态以及是否接受BB + RASI治疗分为六组：血糖正常且使用BB + RASI者（= 2217）或未使用者（= 243），糖尿病前期且使用BB + RASI者（= 2601）或未使用者（= 306），以及糖尿病且使用BB + RASI者（= 3682）或未使用者（= 417）。主要终点是主要不良心脏事件（MACE），定义为全因死亡、再发心肌梗死（Re-MI）或任何再次血运重建，次要终点是心力衰竭住院（HHF）的累积发生率。在接受BB + RASI治疗的患者中，尽管糖尿病前期和糖尿病组之间的主要和次要临床指标相似，但糖尿病组的Re-MI累积发生率（校正风险比：1.660；95%置信区间：1.000 - 2.755；P = 0.020）高于糖尿病前期组。在所有三个不同血糖组中，与未使用BB + RASI者相比，使用BB + RASI者的MACE、心源性死亡和HHF均有所降低。在这项回顾性观察性注册研究中，在两年随访期内，AMI患者中除Re-MI外，BB + RASI治疗在糖尿病前期和糖尿病患者中显示出相当的临床结局。
