Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon.
Cardiovascular Center, Department of Cardiology, Chonnam National University Hospital, Gwangju.
Medicine (Baltimore). 2021 Feb 12;100(6):e24733. doi: 10.1097/MD.0000000000024733.
Studies comparing long-term clinical outcomes of statin treatment between acute myocardial infarction (AMI) patients with prediabetes and those with type 2 diabetes mellitus (T2DM) after successful percutaneous coronary intervention (PCI) with the newer-generation drug-eluting stents (DESs) are limited. We compared 2-year clinical outcomes between these patients.A total of 11,962 AMI patients were classified as statin users (n = 10,243) and statin nonusers (n = 1719). Thereafter, statin users and nonusers were further divided into the normoglycemia, prediabetes, and T2DM groups. The major outcome was the occurrence of major adverse cardiac event (MACE) defined as all-cause death, recurrent myocardial infarction (Re-MI), or any repeat coronary revascularization.After statin treatment, the cumulative incidences of MACE (P = .314), all-cause death, cardiac death (CD), Re-MI, and any repeat revascularization were similar between the prediabetes and T2DM groups. However, the cumulative incidences of MACE (P = .025) and all-cause death (P = .038) in the prediabetes group and those of MACE (P = .001), all-cause death (P = .009), and CD (P = .048) in the T2DM group were significantly higher than those in the normoglycemia group. Moreover, in all the 3 glycemic groups, the cumulative incidences of MACE, all-cause death, and CD were significantly higher among statin nonusers than among statin users.This study revealed that AMI patients with prediabetes had worse clinical outcomes than those with normoglycemia and comparable to those with T2DM after 2-year statin treatment. However, further studies are warranted to confirm the current findings.
比较经皮冠状动脉介入治疗(PCI)后成功使用新一代药物洗脱支架(DES)的急性心肌梗死(AMI)合并糖尿病前期和 2 型糖尿病(T2DM)患者长期临床结局的研究有限。我们比较了这些患者的 2 年临床结局。
共纳入 11962 例 AMI 患者,分为他汀类药物使用者(n=10243)和他汀类药物非使用者(n=1719)。此后,他汀类药物使用者和非使用者进一步分为血糖正常、糖尿病前期和 T2DM 组。主要结局为主要不良心脏事件(MACE)的发生,定义为全因死亡、再发心肌梗死(Re-MI)或任何再次冠状动脉血运重建。
他汀类药物治疗后,糖尿病前期和 T2DM 组之间 MACE(P=0.314)、全因死亡、心源性死亡(CD)、再发心肌梗死和任何再次血运重建的累积发生率相似。然而,糖尿病前期组的 MACE(P=0.025)和全因死亡(P=0.038)以及 T2DM 组的 MACE(P=0.001)、全因死亡(P=0.009)和 CD(P=0.048)的累积发生率均显著高于血糖正常组。此外,在所有 3 组血糖患者中,他汀类药物非使用者的 MACE、全因死亡和 CD 的累积发生率均显著高于他汀类药物使用者。
本研究表明,AMI 合并糖尿病前期患者在他汀类药物治疗 2 年后的临床结局较血糖正常者差,与 T2DM 患者相当。然而,还需要进一步的研究来证实目前的发现。