急性心力衰竭和糖尿病对急性冠状动脉综合征患者的有害协同作用：来自 FAST-MI 注册研究的数据。

Deleterious synergistic effects of acute heart failure and diabetes mellitus in patients with acute coronary syndrome: Data from the FAST-MI Registries.

机构信息

Department of Cardiology, Inserm U942, Lariboisière Hospital, Assistance publique-Hôpitaux de Paris, Université de Paris, 75010 Paris, France.

Department of Cardiology, Les Hôpitaux de Chartres, 28630 Le Coudray, France.

出版信息

Arch Cardiovasc Dis. 2022 May;115(5):264-275. doi: 10.1016/j.acvd.2022.02.004. Epub 2022 Mar 4.

DOI:10.1016/j.acvd.2022.02.004

PMID:35304066

Abstract

BACKGROUND

Diabetes mellitus (DM) predisposes patients to acute myocardial infarction (AMI) and acute heart failure (AHF).

AIMS

To assess correlates of AHF occurring at the early stage of AMI and synergism between early AHF and DM on 5-year mortality.

METHODS

FAST-MI 2005 and 2010 included 7839 consecutive patients admitted for AMI.

RESULTS

Overall, 2151 patients (27.4%) had a history of diabetes mellitus (DM), of whom 629 (29.2%) were on insulin. Patients with versus without DM were older (mean age: 70.0 vs. 64.7years; P<0.001), with more comorbidities and more severe coronary artery disease. Early AHF (pulmonary oedema or cardiogenic shock) was the most frequent in-hospital complication (12.5%) and was twice as frequent in patients with versus without DM (20.2% vs. 9.6%; adjusted odds ratio: 1.66, 95% confidence interval [CI]: 1.43-1.94; P<0.001). Among in-hospital survivors, patients with DM without AHF and those with AHF without DM had 50% increases in 5-year mortality (adjusted hazard ratio [aHR]: 1.50, 95% CI: 1.32-1.69 and aHR: 1.46, 95% CI: 1.23-1.74; both P<0.001) versus patients without DM or AHF; with the risk among those with DM and AHF being doubled (aHR: 1.97, 95% CI: 1.66-2.34; P<0.0001).

CONCLUSION

Early AHF is the most frequent complication of AMI and is twice as common in patients with versus without DM. After adjustment, early AHF and DM are associated with reduced 5-year survival with synergistic effects in patients with both conditions.

CLINICAL TRIAL REGISTRATION

https://clinicaltrials.gov (NCT00673036 and NCT01237418).

摘要

背景

糖尿病（DM）使患者易患急性心肌梗死（AMI）和急性心力衰竭（AHF）。

目的

评估 AMI 早期发生 AHF 的相关因素以及早期 AHF 与 DM 对 5 年死亡率的协同作用。

方法

FAST-MI 2005 和 2010 纳入了 7839 例连续因 AMI 入院的患者。

结果

总体而言，2151 例（27.4%）患者有糖尿病（DM）病史，其中 629 例（29.2%）接受胰岛素治疗。与无 DM 患者相比，DM 患者年龄更大（平均年龄：70.0 岁 vs. 64.7 岁；P<0.001），合并症更多，冠状动脉疾病更严重。早期 AHF（肺水肿或心源性休克）是最常见的院内并发症（12.5%），且在 DM 患者中更为常见（20.2% vs. 9.6%；校正比值比：1.66，95%置信区间[CI]：1.43-1.94；P<0.001）。在院内幸存者中，无 AHF 的 DM 患者和无 DM 但有 AHF 的患者 5 年死亡率增加了 50%（校正风险比[aHR]：1.50，95%CI：1.32-1.69 和 aHR：1.46，95%CI：1.23-1.74；均 P<0.001），而无 DM 或 AHF 的患者死亡率增加了 50%（aHR：1.97，95%CI：1.66-2.34；P<0.0001）。