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糖尿病和非糖尿病人群中非ST段抬高型与ST段抬高型心肌梗死临床结局的比较

Comparison of Clinical Outcomes after Non-ST-Segment and ST-Segment Elevation Myocardial Infarction in Diabetic and Nondiabetic Populations.

作者信息

Kim Yong Hoon, Her Ae-Young, Rha Seung-Woon, Choi Cheol Ung, Choi Byoung Geol, Kim Ji Bak, Park Soohyung, Kang Dong Oh, Park Ji Young, Park Sang-Ho, Jeong Myung Ho

机构信息

Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon 24289, Korea.

Cardiovascular Center, Korea University Guro Hospital, Seoul 08308, Korea.

出版信息

J Clin Med. 2022 Aug 29;11(17):5079. doi: 10.3390/jcm11175079.

Abstract

Using a new-generation drug-eluting stent, we compared the 2-year clinical outcomes of patients with diabetes mellitus (DM) and non-DM concomitant with a non-ST-segment elevation myocardial infarction (NSTEMI) and an ST-segment elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention. A total of 11,798 patients with acute myocardial infarction were classified into two groups: DM (NSTEMI, n = 2399; STEMI, n = 2693) and non-DM (NSTEMI, n = 2694; STEMI, n = 4012). The primary clinical outcome was the occurrence of major adverse cardiac events (MACE), defined as all-cause death, recurrent myocardial infarction, or any coronary repeat revascularization. The secondary outcome was the occurrence of definite or probable stent thrombosis. In all the patients, both multivariable and propensity score-adjusted analyses revealed that the incidence rates of MACE (adjusted hazard ratio (aHR), 1.214; p = 0.006 and aHR, 1.298; p = 0.002, respectively), all-cause death, cardiac death (CD), and non-CD rate were significantly higher in the NSTEMI group than in the STEMI group. Additionally, among patients with NSTEMI, there was a higher non-CD rate (aHR, 2.200; p = 0.007 and aHR, 2.484; p = 0.004, respectively) in the DM group and a higher CD rate (aHR, 2.688; p < 0.001 and 2.882; p < 0.001, respectively) in the non-DM group. In this retrospective study, patients with NSTEMI had a significantly higher 2-year mortality rate than those with STEMI did. Furthermore, strategies to reduce the non-CD rate in patients with DM and the CD rate in patients without DM could be beneficial for those with NSTEMI.

摘要

我们使用新一代药物洗脱支架,比较了糖尿病(DM)患者和非糖尿病患者在伴有非ST段抬高型心肌梗死(NSTEMI)和ST段抬高型心肌梗死(STEMI)时接受经皮冠状动脉介入治疗后的2年临床结局。总共11798例急性心肌梗死患者被分为两组:糖尿病组(NSTEMI,n = 2399;STEMI,n = 2693)和非糖尿病组(NSTEMI,n = 2694;STEMI,n = 4012)。主要临床结局是发生主要不良心脏事件(MACE),定义为全因死亡、复发性心肌梗死或任何冠状动脉再次血运重建。次要结局是发生明确或可能的支架血栓形成。在所有患者中,多变量分析和倾向评分调整分析均显示,NSTEMI组的MACE发生率(调整后风险比(aHR)分别为1.214;p = 0.006和aHR,1.298;p = 0.002)、全因死亡、心源性死亡(CD)和非心源性死亡率均显著高于STEMI组。此外,在NSTEMI患者中,糖尿病组的非心源性死亡率较高(aHR分别为2.200;p = 0.007和aHR,2.484;p = 0.004),而非糖尿病组的心源性死亡率较高(aHR分别为2.688;p < 0.001和2.882;p < 0.001)。在这项回顾性研究中,NSTEMI患者的2年死亡率显著高于STEMI患者。此外,降低糖尿病患者的非心源性死亡率和非糖尿病患者的心源性死亡率的策略可能对NSTEMI患者有益。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6da0/9456669/5262b68f6b5b/jcm-11-05079-g001.jpg

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