MONIKA/KORA Myocardial Infarction Registry, University Hospital of Augsburg, Augsburg, Germany.
Chair of Epidemiology, LMU München at UNIKA-T Augsburg, Augsburg, Germany.
Sci Rep. 2021 Mar 18;11(1):6307. doi: 10.1038/s41598-021-85674-9.
Prior studies examined association between short-term mortality and certain changes in the admission ECG in acute myocardial infarction (AMI). Nevertheless, little is known about possible differences between patients with diabetes and without diabetes in this regard. So the aim of the study was to investigate the association between 28-day case fatality according to certain ECG changes comparing AMI cases with and without diabetes from the general population. From 2000 until 2017 a total of 9756 AMI cases was prospectively recorded in the study Area of Augsburg, Germany. Each case was assigned to one of the following groups according to admission ECG: 'ST-elevation', 'ST-depression', 'only T-negativity', 'predominantly bundle branch block', 'unspecific changes' and 'normal ECG' (the last two were put together for regression analyses). Multivariable adjusted logistic regression models were calculated to compare 28-day case-fatality between the ECG groups for the total sample and separately for diabetes and non-diabetes cases. For the non-diabetes group, the parsimonious logistic regression model revealed significantly better 28-day-outcome for the 'normal ECG / unspecific changes' group (OR: 0.47 [0.29-0.76]) compared to the reference group (STEMI). Contrary, in AMI cases with diabetes the category 'normal ECG / unspecific changes' was not significantly associated with lower short-term mortality (OR: 0.87 [0.49-1.54]). Neither of the other ECG groups was significantly associated with 28-day-mortality in the parsimonious logistic regression models. Consequently, the absence of AMI-typical changes in the admission ECG predicts favorable short-term mortality only in non-diabetic cases, but not so in patients with diabetes.
先前的研究考察了短期死亡率与急性心肌梗死（AMI）入院心电图某些变化之间的关系。然而，在这方面，关于糖尿病患者和非糖尿病患者之间可能存在的差异，人们知之甚少。因此，本研究的目的是调查在一般人群中，比较糖尿病和非糖尿病 AMI 患者的入院心电图某些变化与 28 天病死率之间的关系。从 2000 年到 2017 年，德国奥格斯堡研究区域前瞻性记录了总共 9756 例 AMI 病例。根据入院心电图，每个病例被分为以下几组之一：“ST 段抬高”、“ST 段压低”、“仅 T 波倒置”、“优势束支传导阻滞”、“非特异性改变”和“正常心电图”（后两者合并用于回归分析）。多变量调整逻辑回归模型用于比较总样本以及糖尿病和非糖尿病病例中各心电图组之间的 28 天病死率。对于非糖尿病组，简约逻辑回归模型显示“正常心电图/非特异性改变”组（OR：0.47 [0.29-0.76]）的 28 天预后显著优于参考组（STEMI）。相反，在伴有糖尿病的 AMI 病例中，“正常心电图/非特异性改变”类别与短期死亡率降低无关（OR：0.87 [0.49-1.54]）。在简约逻辑回归模型中，其他心电图组均与 28 天病死率无显著相关性。因此，入院心电图中 AMI 典型改变的缺失仅在非糖尿病患者中预测短期死亡率良好，但在糖尿病患者中并非如此。
