急诊住院患者糖尿病与心肌损伤的临床特征及其预后意义。
Clinical characteristics and prognostic implications of diabetes and myocardial injury in patients admitted to the emergency room.
机构信息
Department of Cardiology, Joan XXIII University Hospital, Calle Dr Mallafré Guash 4, 43005, Tarragona, Spain.
Pere Virgili Health Research Institute (IISPV), Tarragona, Spain.
出版信息
BMC Cardiovasc Disord. 2021 Aug 30;21(1):414. doi: 10.1186/s12872-021-02220-1.
BACKGROUND
This study aimed to investigate the clinical features and prognosis of diabetes and myocardial injury in patients admitted to the emergency department.
METHODS
We analyzed the clinical data of all consecutive patients admitted to the emergency department during the years 2012 and 2013 with at least 1 cardiac Troponin I (cTnI Ultra Siemens, Advia Centaur) determination, and were classified according to the status of diabetes mellitus (DM) and myocardial injury (MI). Clinical events were evaluated in a 4-year follow-up.
RESULTS
A total of 3622 patients were classified according to the presence of DM (n = 924 (25.55%)) and MI (n = 1049 (28.96%)). The proportion of MI in patients with DM was 40% and 25% in patients without DM. Mortality during follow-up was 10.9% in non-DM patients without MI, 21.3% in DM patients without MI, 40.1% in non-DM patients with MI, and 52.8% in DM patients with MI. A competitive risk model was used to obtain the Hazard Ratio (HR) for readmission for myocardial infarction or heart failure. There was a similar proportion of readmission for myocardial infarction and heart failure at a four-year follow-up in patients with DM or MI, which was much higher when DM was associated with MI, with respect to patients without DM or MI. The HR (95% Coefficient Interval) for myocardial infarction in the DM without MI, non-DM with MI, and DM with MI groups with respect to the non-DM without MI group was 2511 (1592-3960), 2682 (1739-4138), and 5036 (3221-7876), respectively. The HR (95% CI) for the risk of readmission for heart failure in the DM without MI, non-DM with MI, and DM with MI groups with respect to the non-DM without MI group was 2663 (1825-3886), 2562 (1753-3744) and 4292 (2936-6274), respectively.
CONCLUSIONS
The association of DM and MI in patients treated in an Emergency Service identifies patients at very high risk of mortality and cardiovascular events.
背景
本研究旨在探讨急诊科收治的糖尿病和心肌损伤患者的临床特征和预后。
方法
我们分析了 2012 年和 2013 年期间至少有 1 次心脏肌钙蛋白 I（cTnI Ultra Siemens，Advia Centaur）测定值的连续入住急诊科患者的临床数据，并根据糖尿病（DM）和心肌损伤（MI）的情况进行分类。在 4 年的随访中评估临床事件。
结果
根据是否存在 DM（n=924（25.55%））和 MI（n=1049（28.96%）），共对 3622 例患者进行了分类。DM 患者中 MI 的比例为 40%，非 DM 患者中 MI 的比例为 25%。无 MI 的非 DM 患者随访期间的死亡率为 10.9%，无 MI 的 DM 患者为 21.3%，有 MI 的非 DM 患者为 40.1%，有 MI 的 DM 患者为 52.8%。使用竞争风险模型获得因心肌梗死或心力衰竭再次入院的风险比（HR）。在 DM 或 MI 患者中，4 年随访时因心肌梗死和心力衰竭再次入院的比例相似，但当 DM 合并 MI 时，与无 DM 或 MI 的患者相比，再次入院的比例要高得多。DM 无 MI、非 DM 有 MI 和 DM 有 MI 组与非 DM 无 MI 组相比，心肌梗死的 HR（95%置信区间）分别为 2511（1592-3960）、2682（1739-4138）和 5036（3221-7876）。DM 无 MI、非 DM 有 MI 和 DM 有 MI 组与非 DM 无 MI 组相比，心力衰竭再次入院的 HR（95%CI）分别为 2663（1825-3886）、2562（1753-3744）和 4292（2936-6274）。
结论
急诊科治疗的 DM 和 MI 并存患者，其死亡率和心血管事件风险极高。
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