应激性高血糖比值对合并与不合并糖尿病的急性心肌梗死患者预后的影响。

Prognostic impact of stress hyperglycemia ratio in acute myocardial infarction patients with and without diabetes mellitus.

机构信息

Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.

出版信息

Nutr Metab Cardiovasc Dis. 2022 Oct;32(10):2356-2366. doi: 10.1016/j.numecd.2022.07.004. Epub 2022 Jul 16.

DOI:10.1016/j.numecd.2022.07.004

PMID:35965248

Abstract

BACKGROUND AND AIMS

Stress hyperglycemia ratio (SHR) is associated with increased in-hospital morbidity and mortality in patients with acute myocardial infarction (AMI). We aimed to investigate the impact of stress "hyperglycemia" on long-term mortality after AMI in patients with and without diabetes mellitus (DM).

METHODS AND RESULTS

We included 2089 patients with AMI between February 2014 and March 2018. SHR was measured with the fasting glucose divided by the estimated average glucose derived from glycosylated hemoglobin (HbA1c). The primary endpoint was all-cause death. Of 2 089 patients (mean age: 65.7 ± 12.4, 76.7% were men) analyzed, 796 (38.1%) had DM. Over a median follow-up of 2.7 years, 141 (6.7%) and 150 (7.2%) all-cause deaths occurred in the diabetic and nondiabetic cohorts, respectively. Compared with participants with low SHR (<1.24 in DM; <1.14 in non-DM), the hazard ratios and 95% confidence intervals for those with high SHR (≥1.24 in DM; ≥1.14 in non-DM) for all-cause mortality were 2.23 (1.54-3.23) and 1.79 (1.15-2.78); for cardiovascular mortality were 2.42 (1.63-3.59) and 2.10 (1.32-3.35) in DM and non-DM subjects, respectively. The mortality prediction was improved in the diabetic individuals with the incorporation of SHR into the Global Registry of Acute Coronary Events (GRACE) score, showing an increase in a continuous net reclassification index of 0.184 (95%CI: 0.003-0.365) and an absolute integrated discrimination improvement of 0.014 (95%CI: 0.002-0.025).

CONCLUSION

The improvement in the prediction of long-term mortality beyond the GRACE score indicates the potential of SHR as a biomarker for post-MI risk stratification among patients with DM.

REGISTRATION NUMBER FOR CLINICAL TRIALS

NCT03533543.

摘要

背景与目的

应激性高血糖比值（SHR）与急性心肌梗死（AMI）患者住院期间发病率和死亡率的增加有关。我们旨在研究应激性“高血糖”对伴有和不伴有糖尿病（DM）的 AMI 患者长期死亡率的影响。

方法和结果

我们纳入了 2014 年 2 月至 2018 年 3 月间 2089 例 AMI 患者。SHR 通过空腹血糖除以糖化血红蛋白（HbA1c）得出的估计平均血糖来测量。主要终点为全因死亡。在分析的 2089 例患者（平均年龄：65.7±12.4，76.7%为男性）中，796 例（38.1%）患有 DM。中位随访 2.7 年后，糖尿病组和非糖尿病组分别有 141 例（6.7%）和 150 例（7.2%）发生全因死亡。与 SHR 较低的患者（DM 组<1.24；非 DM 组<1.14）相比，SHR 较高的患者（DM 组≥1.24；非 DM 组≥1.14）的全因死亡风险比（HR）及其 95%置信区间分别为 2.23（1.54-3.23）和 1.79（1.15-2.78）；心血管死亡风险比分别为 2.42（1.63-3.59）和 2.10（1.32-3.35）。DM 患者和非 DM 患者将 SHR 纳入全球急性冠状动脉事件注册（GRACE）评分后，死亡率预测得到改善，连续净重新分类指数增加了 0.184（95%CI：0.003-0.365），绝对综合区分度改善了 0.014（95%CI：0.002-0.025）。