Schmitz Timo, Harmel Eva, Heier Margit, Peters Annette, Linseisen Jakob, Meisinger Christa
Chair of Epidemiology, University Hospital Augsburg, University of Augsburg, Augsburg, Germany.
Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany.
Front Cardiovasc Med. 2022 Apr 25;9:869395. doi: 10.3389/fcvm.2022.869395. eCollection 2022.
In this study we investigated the prevalence of undiagnosed impaired glucose tolerance and type-2-diabetes (T2D) among patients with acute myocardial infarction (AMI) and prospectively analyzed whether these patients have a higher long-term mortality.
The analysis was based on 2,317 AMI patients aged 25-84 years from the population-based Myocardial Infarction Registry Augsburg, recruited between 2009 and 2014 and followed-up until 2019 (median follow-up time 6.5 years [IQR: 4.9-8.1]). AMI patients with a diagnosis of diabetes were divided into a high (>7.0%) and a low HbA1c group (≤7.0%) according to HbA1c values at admission. The remaining patients (without known diabetes) were grouped into normal (<5.7%), elevated (5.7-6.4%), and high (≥6.5%) HbA1c groups. In a multivariable-adjusted COX regression analysis, the association between HbA1c groups and long-term mortality was investigated. Linear regression models were used to identify AMI patients with elevated HbA1c values by means of personal characteristics.
At admission, 29.5% of all patients reported a diagnosis of diabetes. Of all patients without known diabetes, 5.4% had HbA1c values of ≥ 6.5 and 37.9% had HbA1c values between 5.7 and 6.4%. The fully adjusted Cox regression model showed a non-significant trend toward higher long-term mortality for AMI patients with increased HbA1c values (HbA1c 5.7-6.4% HR: 1.05 [0.79-1.38], HbA1c > 6.5% HR: 1.34 [0.77-2.31]). A linear regression model including the variables admission serum glucose, BMI, age, sex and type of infarction (STEMI, NSTEMI) showed only poor prediction of HbA1c values ( : 11.08%).
A fairly high number of AMI patients without known diabetes have elevated HbA1c values. Though we could not prove a higher risk of premature mortality in these patients, early detection and adequate therapy might lead to reduced diabetes-associated complications and improve long-term outcomes.
在本研究中，我们调查了急性心肌梗死（AMI）患者中未诊断出的糖耐量受损和2型糖尿病（T2D）的患病率，并前瞻性分析了这些患者是否有更高的长期死亡率。
分析基于2009年至2014年招募的、年龄在25 - 84岁之间、来自奥格斯堡基于人群的心肌梗死登记处的2317例AMI患者，随访至2019年（中位随访时间6.5年[四分位间距：4.9 - 8.1]）。诊断为糖尿病的AMI患者根据入院时的糖化血红蛋白（HbA1c）值分为高（>7.0%）和低HbA1c组（≤7.0%）。其余患者（无已知糖尿病）分为正常（<5.7%）、升高（5.7 - 6.4%）和高（≥6.5%）HbA1c组。在多变量调整的COX回归分析中，研究了HbA1c组与长期死亡率之间的关联。使用线性回归模型通过个人特征识别HbA1c值升高的AMI患者。
入院时，所有患者中有29.5%报告诊断为糖尿病。在所有无已知糖尿病的患者中，5.4%的HbA1c值≥6.5，37.9%的HbA1c值在5.7至6.4之间。完全调整的Cox回归模型显示，HbA1c值升高的AMI患者长期死亡率有升高的非显著趋势（HbA1c 5.7 - 6.4% 风险比：1.05 [0.79 - 1.38]，HbA1c > 6.5% 风险比：1.34 [0.77 - 2.31]）。包含入院血清葡萄糖、体重指数、年龄、性别和梗死类型（ST段抬高型心肌梗死、非ST段抬高型心肌梗死）变量的线性回归模型对HbA1c值的预测效果较差（解释度：11.08%）。
相当数量无已知糖尿病的AMI患者HbA1c值升高。尽管我们无法证明这些患者过早死亡风险更高，但早期检测和适当治疗可能会减少糖尿病相关并发症并改善长期预后。
