ST段抬高型心肌梗死中的糖尿病与血管再通不全
Diabetes and Incomplete Revascularisation in ST Elevation Myocardial Infarction.
作者信息
Burgess Sonya N, Juergens Craig P, Nguyen Tuan, Leung Melissa, Robledo Kristy P, Thomas Liza, Mussap Christian, Lo Sidney T H, French John K
机构信息
Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; University of New South Wales Liverpool Clinical School, Sydney, NSW, Australia; Cardiology Department, Nepean Hospital, Sydney, NSW, Australia; University of Sydney, Nepean Clinical School, Sydney, NSW, Australia. Electronic address: https://twitter.com/drsonyaburgess.
Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; University of New South Wales Liverpool Clinical School, Sydney, NSW, Australia.
出版信息
Heart Lung Circ. 2021 Apr;30(4):471-480. doi: 10.1016/j.hlc.2020.09.928. Epub 2020 Nov 4.
BACKGROUND
Incomplete revascularisation is common and prognostically important. The degree to which incomplete revascularisation (IR) is associated with adverse cardiac outcomes in patients with diabetes and ST-elevation myocardial infarction (STEMI) is unknown.
METHODS
Late outcomes (3.6 years) were evaluated in 589 consecutive STEMI patients treated with percutaneous coronary intervention in this observational study. Associations between incomplete revascularisation, and diabetes were assessed. A residual SYNergy Between Percutaneous Coronary Intervention With TAXus and Cardiac Surgery (SYNTAX) Score (rSS) >8 defined IR. The primary endpoint studied was cardiac death, myocardial infarction or cerebrovascular accident.
RESULTS
Incomplete revascularisation occurred in 36% of patients with diabetes (46/127) and 32% of patients without diabetes (147/462); p=0.329. The primary endpoint occurred in 27% of patients with diabetes compared to 18% of patients without diabetes (p=0.042); and in 28% with a rSS>8 compared to 16% of patients with a rSS≤8 (p<0.001). The primary endpoint occurred in 35% of patients with both diabetes and a rSS>8, 27% without diabetes with a rSS>8, 22% with diabetes and a rSS≤8, and 14% of with patients neither factor (p<0.001), with cardiac death rates respectively of 22%, 9%, 6%, 2% (p<0.001). Patients with both IR and diabetes accounted for only 8% of STEMI patients but 30% of all cardiac deaths. On multivariable analyses diabetes and IR were independently associated with cardiac death, myocardial infarction and cerebrovascular accident; both p<0.05.
CONCLUSIONS
Diabetes and IR contribute independently to late outcomes in STEMI patients. The prognostic impact of diabetes was not due to IR alone. Diabetes acts synergistically with incomplete revascularisation to worsen prognosis.
背景
血管再通不完全很常见且对预后有重要影响。在糖尿病合并ST段抬高型心肌梗死（STEMI）患者中，血管再通不完全（IR）与不良心脏结局的关联程度尚不清楚。
方法
在这项观察性研究中，对589例接受经皮冠状动脉介入治疗的连续性STEMI患者的晚期结局（3.6年）进行了评估。评估了血管再通不完全与糖尿病之间的关联。残余的经皮冠状动脉介入治疗与心脏手术协同作用（SYNTAX）评分（rSS）>8定义为IR。研究的主要终点是心源性死亡、心肌梗死或脑血管意外。
结果
糖尿病患者中36%（46/127）发生血管再通不完全，非糖尿病患者中32%（147/462）发生血管再通不完全；p = 0.329。糖尿病患者中27%发生主要终点，非糖尿病患者中为18%（p = 0.042）；rSS>8的患者中28%发生主要终点，rSS≤8的患者中为16%（p<0.001）。糖尿病且rSS>8的患者中35%发生主要终点，非糖尿病且rSS>8的患者中27%发生主要终点，糖尿病且rSS≤8的患者中22%发生主要终点，两者因素均无的患者中14%发生主要终点（p<0.001），心源性死亡率分别为22%、9%、6%、2%（p<0.001）。血管再通不完全且合并糖尿病的患者仅占STEMI患者的8%，但占所有心源性死亡的30%。多变量分析显示，糖尿病和血管再通不完全独立与心源性死亡、心肌梗死和脑血管意外相关；两者p<0.05。
结论
糖尿病和血管再通不完全独立影响STEMI患者的晚期结局。糖尿病的预后影响并非仅由血管再通不完全所致。糖尿病与血管再通不完全协同作用使预后恶化。
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