Venkateswaran Ramkumar V, Moorthy M V, Chatterjee Neal A, Pester Julie, Kadish Alan H, Lee Daniel C, Cook Nancy R, Albert Christine M
Division of Cardiology, University of California-San Francisco, San Francisco, California, USA.
Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
JACC Clin Electrophysiol. 2021 Dec;7(12):1604-1614. doi: 10.1016/j.jacep.2021.05.014. Epub 2021 Jul 28.
This study sought to determine the absolute and relative associations of diabetes mellitus (DM) and hemoglobin A (HbA) with sudden and/or arrhythmic death (SAD) versus other modes of death in patients with coronary artery disease (CAD) who do not qualify for implantable cardioverter-defibrillators.
Patients with CAD and DM are at elevated risk for SAD; however, it is unclear whether these patients would benefit from implantable cardioverter-defibrillators given competing causes of death and/or whether HbA might augment SAD risk stratification.
In the PRE-DETERMINE study of 5,764 patients with CAD with left ventricular ejection fraction (LVEF) of >30% to 35%, competing risk analyses were used to compare the absolute and relative risks of SAD versus non-SAD by DM status and HbA level and to identify risk factors for SAD among 1,782 patients with DM.
Over a median follow-up of 6.8 years, DM and HbA were significantly associated with SAD and non-SAD (P < 0.05 for all comparisons); however, the cumulative incidence of non-SAD (19.2%; 95% CI: 17.3%-21.2%) was almost 4 times higher than SAD (4.8%; 95% CI: 3.8%-5.9%) in DM patients. A similar pattern of absolute risk was observed across categories of HbA. In analyses limited to patients with DM, HbA was not associated with SAD, whereas low LVEF, atrial fibrillation, and electrocardiogram measurements were associated with higher SAD risk.
In patients with CAD and LVEF of >30% to 35%, patients with DM and/or elevated HbA are at much higher absolute risk of dying from non-SAD than SAD. Clinical risk markers, and not HbA, were associated with SAD risk in patients with DM. (PRE-DETERMINE: Biologic Markers and MRI SCD Cohort Study; NCT01114269).
本研究旨在确定糖尿病（DM）和糖化血红蛋白（HbA）与冠状动脉疾病（CAD）患者中不符合植入式心脏复律除颤器植入条件的猝死和/或心律失常性死亡（SAD）以及其他死亡方式之间的绝对关联和相对关联。
CAD和DM患者发生SAD的风险升高；然而，鉴于存在其他死亡原因，尚不清楚这些患者是否会从植入式心脏复律除颤器中获益，以及HbA是否可能增强SAD风险分层。
在一项针对5764例左心室射血分数（LVEF）>30%至35%的CAD患者的PRE-DETERMINE研究中，采用竞争风险分析来比较按DM状态和HbA水平划分的SAD与非SAD的绝对风险和相对风险，并在1782例DM患者中确定SAD的危险因素。
在中位随访6.8年期间，DM和HbA与SAD和非SAD均显著相关（所有比较P<0.05）；然而，DM患者中非SAD的累积发生率（19.2%；95%CI：17.3%-21.2%）几乎是非SAD的4倍（4.8%；95%CI：3.8%-5.9%）。在HbA各分类中观察到类似的绝对风险模式。在仅限于DM患者的分析中，HbA与SAD无关，而低LVEF、心房颤动和心电图测量结果与较高的SAD风险相关。
在LVEF>30%至35%的CAD患者中，DM和/或HbA升高的患者死于非SAD的绝对风险远高于死于SAD的风险。临床风险标志物而非HbA与DM患者的SAD风险相关。（PRE-DETERMINE：生物标志物与MRI SCD队列研究；NCT01114269）
