糖尿病对 2019 冠状病毒病大流行期间急性心肌梗死患者急诊救治的影响：一项全国范围内基于人群的研究。

Impact of diabetes on emergency care of acute myocardial infarction patients during the coronavirus disease 2019 pandemic: a nationwide population-based study.

机构信息

Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.

Division of Medical Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.

出版信息

Front Public Health. 2023 Apr 26;11:1151506. doi: 10.3389/fpubh.2023.1151506. eCollection 2023.

DOI:10.3389/fpubh.2023.1151506

PMID:37181708

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10169718/

Abstract

BACKGROUND

Although acute myocardial infarction (AMI) requires timely intervention, limited nationwide data is available regarding the association between disruption of emergency services and outcomes of patients with AMI during the coronavirus disease 2019 (COVID-19) pandemic. Moreover, whether diabetes mellitus (DM) adversely affects disease severity in these patients has not yet been investigated.

METHODS

This nationwide population-based study analyzed 45,648 patients with AMI, using data from the national registry of emergency departments (ED) in Korea. Frequency of ED visits and disease severity were compared between the COVID-19 outbreak period (year 2020) and the control period (the previous year 2019).

RESULTS

The number of ED visits by patients with AMI decreased during the first, second, and third waves of the outbreak period compared to the corresponding time period in the control period (all -values < 0.05). A longer duration from symptom onset to ED visit ( = 0.001) and ED stay ( = 0.001) and higher rates of resuscitation, ventilation care, and extracorporeal membrane oxygen insertion were observed during the outbreak period than during the control period (all -values < 0.05). These findings were exacerbated in patients with comorbid DM; Compared to patients without DM, patients with DM demonstrated delayed ED visits, longer ED stays, more intensive care unit admissions ( < 0.001), longer hospitalizations ( < 0.001), and higher rates of resuscitation, intubation, and hemodialysis (all -values < 0.05) during the outbreak period. While in-hospital mortality was similar in AMI patients with and without comorbid DM during the two periods (4.3 vs. 4.4%; = 0.671), patients with DM who had other comorbidities such as chronic kidney disease or heart failure or were aged ≥ 80 years had higher in-hospital mortality compared with those without any of the comorbidities (3.1 vs. 6.0%; < 0.001).

CONCLUSION

During the pandemic, the number of patients with AMI presenting to the ED decreased compared with that of the previous year, while the disease severity increased, particularly in patients with comorbid DM.

摘要

背景

尽管急性心肌梗死（AMI）需要及时干预，但关于在 2019 年冠状病毒病（COVID-19）大流行期间，紧急服务中断与 AMI 患者结局之间的关联，仅有有限的全国性数据。此外，糖尿病（DM）是否会对这些患者的疾病严重程度产生不利影响，目前尚未得到研究。

方法

本项全国性基于人群的研究使用韩国急诊部（ED）国家登记处的数据，分析了 45648 例 AMI 患者。比较了 COVID-19 爆发期间（2020 年）和对照期间（前一年 2019 年）ED 就诊的频率和疾病严重程度。

结果

与对照期间相比，AMI 患者在疫情爆发的第一波、第二波和第三波期间，ED 就诊的人数均减少（均 P<0.05）。从症状发作到 ED 就诊的时间（ =0.001）和 ED 停留时间（ =0.001）更长，复苏、通气护理和体外膜氧合插入的比例在疫情爆发期间更高（均 P<0.05）。在合并 DM 的患者中，这些发现更为严重；与无 DM 的患者相比，有 DM 的患者就诊时间更晚，ED 停留时间更长，更多入住重症监护病房（ <0.001），住院时间更长（ <0.001），复苏、插管和血液透析的比例更高（均 P<0.05）。在两个时期，合并 DM 的 AMI 患者的院内死亡率相似（4.3%比 4.4%； =0.671），但患有其他合并症（如慢性肾脏病或心力衰竭）或年龄≥80 岁的合并 DM 患者的院内死亡率高于无任何合并症的患者（3.1%比 6.0%； <0.001）。