入院高血糖是无糖尿病急性心肌梗死患者长期预后的独立预测因子：一项回顾性研究。
Admission hyperglycemia as an independent predictor of long-term prognosis in acute myocardial infarction patients without diabetes: A retrospective study.
机构信息
Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China.
出版信息
J Diabetes Investig. 2021 Jul;12(7):1244-1251. doi: 10.1111/jdi.13468. Epub 2020 Dec 28.
AIMS/INTRODUCTION: The predictive value of admission hyperglycemia in the long-term prognosis of acute myocardial infarction patients is still controversial. We aimed to investigate this value based on the diabetes status.
MATERIALS AND METHODS
We carried out a multicenter, retrospective study of 1,288 acute myocardial infarction patients enrolled in 11 hospitals between March 2014 and June 2019 in Chengdu, China. The patients were classified into those with diabetes and those without diabetes, each was further divided into: hyperglycemia and non-hyperglycemia subgroups, according to the optimal cut-off value of the blood glucose to predict all-cause mortality during follow up. The end-points were all-cause death and major adverse cardiovascular and cerebrovascular events, including all-cause death, non-fatal myocardial infarction, vessel revascularization and non-fatal stroke.
RESULTS
In the follow-up period of 15 months, we observed 210 (16.3%), 6 (0.5%), 57 (4.4%) and 34 (2.6%) cases of death, non-fatal myocardial infarction, revascularization and non-fatal stroke, respectively. The optimal cut-off values of admission blood glucose for patients with diabetes and patients without diabetes to predict all-cause mortality during follow up were 14.80 and 6.77 mmol/L, respectively. We divided patients with diabetes (n = 331) into hyperglycemia (n = 92) and non-hyperglycemia (n = 239), and patients without diabetes (n = 897) into hyperglycemia (n = 425) and non-hyperglycemia (n = 472). The cumulative rates of all-cause death and major adverse cardiovascular and cerebrovascular events among the patients in each hyperglycemia group was higher than that in the corresponding non-hyperglycemia group (P < 0.001). In patients without diabetes, admission hyperglycemia was an independent predictor of all-cause mortality and major adverse cardiovascular and cerebrovascular events.
CONCLUSION
Admission hyperglycemia was an independent predictor for long-term prognosis in acute myocardial infarction patients without diabetes.
目的/引言：入院时的高血糖对急性心肌梗死患者的长期预后的预测价值仍存在争议。我们旨在根据糖尿病的状态来研究这一价值。
材料与方法
我们在中国成都的 11 家医院进行了一项多中心、回顾性研究，共纳入了 1288 名急性心肌梗死患者。这些患者被分为糖尿病患者和非糖尿病患者，每个患者又根据血糖预测随访期间全因死亡率的最佳截断值进一步分为：高血糖和非高血糖亚组。终点事件为全因死亡和主要不良心脑血管事件，包括全因死亡、非致死性心肌梗死、血管血运重建和非致死性卒中。
结果
在 15 个月的随访期间，我们观察到 210（16.3%）、6（0.5%）、57（4.4%）和 34（2.6%）例死亡、非致死性心肌梗死、血运重建和非致死性卒中等事件。糖尿病患者和非糖尿病患者入院时血糖预测随访期间全因死亡率的最佳截断值分别为 14.80 和 6.77mmol/L。我们将糖尿病患者（n=331）分为高血糖组（n=92）和非高血糖组（n=239），非糖尿病患者（n=897）分为高血糖组（n=425）和非高血糖组（n=472）。每个高血糖组的全因死亡和主要不良心脑血管事件的累积发生率均高于相应的非高血糖组（P<0.001）。在非糖尿病患者中，入院时的高血糖是全因死亡和主要不良心脑血管事件的独立预测因素。
结论
入院时的高血糖是无糖尿病急性心肌梗死患者长期预后的独立预测因素。
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