Humos Basel, Mahfoud Ziyad, Dargham Soha, Al Suwaidi Jassim, Jneid Hani, Abi Khalil Charbel
Department of Research, Weill Cornell Medicine-Qatar, Doha, Qatar.
Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
Front Cardiovasc Med. 2022 Oct 10;9:940035. doi: 10.3389/fcvm.2022.940035. eCollection 2022.
We aimed to assess the impact of hypoglycemia in ST-elevation myocardial infarction (STEMI).
Hypoglycemia increases the risk of mortality in patients with diabetes and high cardiovascular risk.
We used the National Inpatient Sample (2005-2017) database to identify adult patients with STEMI as the primary diagnosis. The secondary diagnosis was hypoglycemia. We compared cardiovascular and socio-economic outcomes between STEMI patients with and without hypoglycemia and assessed temporal trends.
Hypoglycemia tends to complicate 0.17% of all cases hospitalized for STEMI. The mean age (±SD) of STEMI patients hospitalized with hypoglycemia decreased from 67 ± 15 in 2005 to 63 ± 12 in 2017 ( = 0.046). Mortality was stable with time, but the prevalence of ventricular tachycardia, ventricular fibrillation, acute renal failure, cardiogenic shock, total charges, and length of stay (LOS) increased with time ( < 0.05 for all). Compared to non-hypoglycemic patients, those who developed hypoglycemia were older and more likely to be black; only 6.7% had diabetes compared to 28.5% of STEMI patients ( = 0.001). Cardiovascular events were more likely to occur in hypoglycemia: mortality risk increased by almost 2.5-fold (adjusted OR = 2.625 [2.095-3.289]). There was a higher incidence of cardiogenic shock (adjusted OR = 1.718 [1.387-2.127]), atrial fibrillation (adjusted OR = 1.284 [1.025-1.607]), ventricular fibrillation (adjusted OR = 1.799 [1.406-2.301]), and acute renal failure (adjusted OR = 2.355 [1.902-2.917]). Patients who developed hypoglycemia were less likely to have PCI (OR = 0.596 [0.491-0.722]) but more likely to have CABG (OR = 1.792 [1.391-2.308]). They also had a longer in-hospital stay and higher charges/stay.
Hypoglycemia is a rare event in patients hospitalized with STEMI. However, it was found to have higher odds of mortality, arrhythmias, and other comorbidities, irrespective of diabetes.
我们旨在评估低血糖在ST段抬高型心肌梗死（STEMI）中的影响。
低血糖会增加糖尿病患者及心血管疾病高风险患者的死亡风险。
我们使用国家住院患者样本（2005 - 2017年）数据库来确定以STEMI为主要诊断的成年患者。次要诊断为低血糖。我们比较了合并低血糖和未合并低血糖的STEMI患者的心血管及社会经济结局，并评估了时间趋势。
低血糖往往使所有因STEMI住院病例中的0.17%出现并发症。因低血糖住院的STEMI患者的平均年龄（±标准差）从2005年的67±15岁降至2017年的63±12岁（P = 0.046）。死亡率随时间保持稳定，但室性心动过速、心室颤动、急性肾衰竭、心源性休克、总费用和住院时间（LOS）的患病率随时间增加（所有P<0.05）。与未发生低血糖的患者相比，发生低血糖的患者年龄更大，更可能是黑人；只有6.7%患有糖尿病，而STEMI患者中这一比例为28.5%（P = 0.001）。心血管事件在低血糖患者中更易发生：死亡风险增加近2.5倍（校正比值比=2.625[2.095 - 3.289]）。心源性休克（校正比值比=1.718[1.387 - 2.127]）、心房颤动（校正比值比=1.284[1.025 - 1.607]）、心室颤动（校正比值比=1.799[1.406 - 2.301]）和急性肾衰竭（校正比值比=2.355[1.902 - 2.917]）的发生率更高。发生低血糖的患者接受PCI的可能性较小（比值比=0.596[0.491 - 0.722]），但接受CABG的可能性较大（比值比=1.792[1.391 - 2.308]）。他们的住院时间也更长，每次住院费用更高。
低血糖在因STEMI住院的患者中是一种罕见事件。然而，发现无论是否患有糖尿病，低血糖患者的死亡、心律失常及其他合并症的几率更高。
