Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA.
Department of Cardiology, Gobind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
Glob Heart. 2022 Aug 12;17(1):54. doi: 10.5334/gh.1140. eCollection 2022.
Dysglycemia is a major and increasingly prevalent cardiometabolic risk factor worldwide, but is often undiagnosed even in high-risk patients. We evaluated the impact of protocolized screening for dysglycemia on the prevalence of prediabetes and diabetes among patients presenting with ST-segment elevation myocardial infarction (STEMI) in North India.
We conducted a prospective NORIN STEMI registry-based study of patients presenting with STEMI to two government-funded tertiary care medical centers in New Delhi, India, from January to November 2019. Hemoglobin A1c (HbA1c) was collected at presentation as part of the study protocol, irrespective of baseline glycemic status.
Among 3,523 participants (median age 55 years), 855 (24%) had known diabetes. In this group, baseline treatment with statins, sodium-glucose cotransporter 2 inhibitors, or glucagon-like peptide-1 receptor agonists was observed in 14%, <1%, and 1% of patients, respectively. For patients without known diabetes, protocolized inpatient screening identified 737 (28%) to have prediabetes (HbA1c 5.7-6.4%) and 339 (13%) to have newly detected diabetes (HbA1c ≥ 6.5%). Patients with prediabetes (49%), newly detected diabetes (53%), and established diabetes (48%) experienced higher rates of post-MI LV dysfunction as compared to euglycemic patients (42%). In-hospital mortality (5.6% for prediabetes, 5.1% for newly detected diabetes, 10.3% for established diabetes, 4.3% for euglycemia) and 30-day mortality (8.1%, 7.6%, 14.4%, 6.6%) were higher in patients with dysglycemia. Compared with euglycemia, prediabetes (adjusted odds ratio (aOR) 1.44 [1.12-1.85]), newly detected diabetes (aOR 1.57 [1.13-2.18]), and established diabetes (aOR 1.51 [1.19-1.94]) were independently associated with higher odds of composite 30-day all-cause mortality or readmission.
Among patients presenting with STEMI in North India, protocolized HbA1c screening doubled the proportion of patients with known dysglycemia. Dysglycemia was associated with worse clinical outcomes at 30 days, and use of established pharmacotherapeutic risk-reduction strategies among patients with known diabetes was rare, highlighting missed opportunities for screening and management of dysglycemia among high-risk patients in North India.
高血糖是全球范围内主要且日益普遍的心血管代谢风险因素，但即使在高危患者中，也常常未被诊断出来。我们评估了在印度北部接受 ST 段抬高型心肌梗死（STEMI）治疗的患者中，针对高血糖进行规范化筛查对糖尿病前期和糖尿病患病率的影响。
我们进行了一项前瞻性的 NORIN STEMI 基于登记的研究，纳入了 2019 年 1 月至 11 月期间在印度新德里的两家政府资助的三级护理医疗中心就诊的 STEMI 患者。在研究过程中，无论基线血糖状态如何，都会在就诊时采集糖化血红蛋白（HbA1c）。
在 3523 名参与者中（中位年龄为 55 岁），855 名（24%）患有已知糖尿病。在该组中，基线治疗中使用他汀类药物、钠-葡萄糖共转运蛋白 2 抑制剂或胰高血糖素样肽-1 受体激动剂的患者比例分别为 14%、<1%和 1%。对于没有已知糖尿病的患者，规范化住院筛查发现 737 名（28%）患有糖尿病前期（HbA1c 5.7-6.4%），339 名（13%）新诊断为糖尿病（HbA1c≥6.5%）。与血糖正常的患者相比，糖尿病前期（49%）、新诊断的糖尿病（53%）和已确诊的糖尿病（48%）患者发生心肌梗死后左心室功能障碍的比率更高。与血糖正常的患者相比，高血糖患者的住院死亡率（糖尿病前期为 5.6%，新诊断的糖尿病为 5.1%，已确诊的糖尿病为 10.3%，血糖正常为 4.3%）和 30 天死亡率（糖尿病前期为 8.1%，新诊断的糖尿病为 7.6%，已确诊的糖尿病为 14.4%，血糖正常为 6.6%）更高。与血糖正常相比，糖尿病前期（校正优势比[aOR] 1.44[1.12-1.85]）、新诊断的糖尿病（aOR 1.57[1.13-2.18]）和已确诊的糖尿病（aOR 1.51[1.19-1.94]）与 30 天复合全因死亡率或再入院的风险增加独立相关。
在印度北部接受 STEMI 治疗的患者中，针对 HbA1c 的规范化筛查使已知高血糖患者的比例增加了一倍。高血糖与 30 天的不良临床结局相关，而已知糖尿病患者中使用既定的药物治疗降低风险策略的情况罕见，这突出表明了在印度北部高危患者中筛查和管理高血糖的机会被错失。
