Chen Huang-Chung, Liu Wen-Hao, Tseng Chien-Hao, Chen Yung-Lung, Lee Wei-Chieh, Fang Yen-Nan, Chong Shaur-Zheng, Chen Mien-Cheng
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taiwan.
J Diabetes Res. 2022 Mar 28;2022:6758297. doi: 10.1155/2022/6758297. eCollection 2022.
Type 2 diabetes was associated with a higher risk for permanent pacemaker (PPM) treatment. The difference in cardiovascular outcomes between patients with and without diabetes receiving PPM treatment remains unexplored.
Between January 2003 and December 2017, 1742 patients receiving naïve PPM treatment comprised this retrospective cohort study and were categorized into two groups by the diagnosis of diabetes: group with diabetes ( = 632, 36.3%) and group without diabetes ( = 1110, 63.7%). The primary outcome was cardiovascular events including heart failure (HF) hospitalization and acute myocardial infarction (AMI). The secondary outcomes of this study included pacemaker infection, pacing-induced cardiomyopathy, cerebrovascular accident, cardiovascular mortality, and all-cause mortality. Propensity score matching (PSM) was applied to reduce selection bias between the study groups.
During a mean follow-up period of 7.8 ± 4.8 years, 264 patients had a cardiovascular event. Before PSM, the incidence of cardiovascular events was higher in patients with diabetes compared to patients without diabetes (19.8% vs. 12.5%, < 0.001), and the incidences of pacing-induced cardiomyopathy, cardiovascular mortality, and all-cause mortality were all higher in patients with diabetes compared to patients without diabetes. After PSM, the incidence of cardiovascular events was higher in patients with diabetes compared to patients without diabetes (18.8% vs. 12.3%, = 0.015). The incidence of HF hospitalization was higher in patients with diabetes compared to patients without diabetes (15.3% vs. 10.2%, = 0.037), whereas the incidence of AMI did not differ between the two groups. Moreover, after PSM, patients with diabetes had higher cumulative incidences of pacing-induced cardiomyopathy and all-cause mortality compared to patients without diabetes.
The prevalence of diabetes was over one-third of naïve PPM recipients of this cohort, and diabetes increased the risk of cardiovascular events in PPM recipients, especially for HF hospitalization.
2型糖尿病与永久性起搏器（PPM）治疗的较高风险相关。接受PPM治疗的糖尿病患者和非糖尿病患者的心血管结局差异仍未得到探索。
在2003年1月至2017年12月期间，1742例接受初次PPM治疗的患者纳入了这项回顾性队列研究，并根据糖尿病诊断分为两组：糖尿病组（n = 632，36.3%）和非糖尿病组（n = 1110，63.7%）。主要结局是心血管事件，包括心力衰竭（HF）住院和急性心肌梗死（AMI）。本研究的次要结局包括起搏器感染、起搏诱导的心肌病、脑血管意外、心血管死亡率和全因死亡率。应用倾向评分匹配（PSM）以减少研究组之间的选择偏倚。
在平均随访7.8±4.8年期间，264例患者发生了心血管事件。在PSM之前，糖尿病患者的心血管事件发生率高于非糖尿病患者（19.8%对12.5%，P<0.001），并且糖尿病患者的起搏诱导的心肌病、心血管死亡率和全因死亡率均高于非糖尿病患者。PSM之后，糖尿病患者的心血管事件发生率高于非糖尿病患者（18.8%对12.3%，P = 0.015）。糖尿病患者的HF住院发生率高于非糖尿病患者（15.3%对10.2%，P = 0.037），而两组之间的AMI发生率没有差异。此外，PSM之后，糖尿病患者的起搏诱导的心肌病和全因死亡率的累积发生率高于非糖尿病患者。
该队列中初次接受PPM治疗的患者中糖尿病患病率超过三分之一，并且糖尿病增加了PPM接受者发生心血管事件的风险，尤其是HF住院。
