Nadarajah Ramesh, Ludman Peter, Laroche Cécile, Appelman Yolande, Brugaletta Salvatore, Budaj Andrzej, Bueno Hector, Huber Kurt, Kunadian Vijay, Leonardi Sergio, Lettino Maddalena, Milasinovic Dejan, Ajjan Ramzi, Marx Nikolaus, Gale Chris P
Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, UK.
Leeds Institute of Data Analytics, University of Leeds, UK.
Eur Heart J Qual Care Clin Outcomes. 2024 Dec 19;10(8):709-722. doi: 10.1093/ehjqcco/qcae002.
Diabetes mellitus (diabetes) is common amongst patients with non-ST-segment elevation myocardial infarction (NSTEMI). We describe presentation, care, and outcomes of patients admitted with NSTEMI by diabetes status.
Prospective cohort study including 2928 patients (1104 with prior diabetes, 1824 without) admitted to hospital with NSTEMI from 287 centres in 59 countries. Quality of care was evaluated based on 12 guideline-recommended care interventions. Outcomes included in-hospital acute heart failure, cardiogenic shock, repeat myocardial infarction, stroke/transient ischaemic attack (TIA), BARC Type ≥ 3 bleeding and death, as well as 30-day mortality. Patients with diabetes had higher comorbidity burden and more frequently presented with Killip Class II-IV heart failure (10.2% vs. 3.7%, P < 0.001), haemodynamic instability (7.1% vs. 3.7%, P < 0.001), and ongoing chest pain (43.1% vs. 37.0%, P < 0.001), than those without diabetes. Overall, care quality received was similar by diabetes status (60.0% vs. 60.5% received ≥ 80% of eligible care interventions, P = 0.786), but patients with diabetes experienced higher rates of in-hospital acute heart failure (15.3% vs. 6.8% P < 0.001), cardiogenic shock (4.5% vs. 2.5%, P = 0.002), stroke/TIA (2.0% vs. 0.8%, P = 0.006), and death (2.5% vs. 1.4%, P = 0.022), and higher 30-day mortality (3.3% vs. 2.0%, P = 0.025). Of NSTEMI with diabetes, only 1.9% and 9.0% received prescription for glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors, respectively, on discharge, and only 45.9% were referred for cardiac rehabilitation.
NSTEMI patients with diabetes, compared with those without, present more clinically unwell and have worse outcomes despite receiving equal quality of care. Prescription of cardiovascular-protective glycaemic agents is an actionable target to reduce risk of further events.
糖尿病在非ST段抬高型心肌梗死（NSTEMI）患者中很常见。我们描述了根据糖尿病状态入院的NSTEMI患者的临床表现、治疗及预后情况。
一项前瞻性队列研究，纳入了来自59个国家287个中心的2928例因NSTEMI入院的患者（1104例既往有糖尿病，1824例无糖尿病）。基于12项指南推荐的治疗干预措施评估治疗质量。结局指标包括院内急性心力衰竭、心源性休克、再发心肌梗死、卒中/短暂性脑缺血发作（TIA）、BARC≥3型出血和死亡，以及30天死亡率。与无糖尿病患者相比，糖尿病患者合并症负担更重，更常表现为Killip II-IV级心力衰竭（10.2%对3.7%，P<0.001）、血流动力学不稳定（7.1%对3.7%，P<0.001）和持续性胸痛（43.1%对37.0%，P<0.001）。总体而言，不同糖尿病状态患者接受的治疗质量相似（60.0%对60.5%接受了≥80%的符合条件的治疗干预措施，P=0.786），但糖尿病患者院内急性心力衰竭（15.3%对6.8%，P<0.001）、心源性休克（4.5%对2.5%，P=0.002）、卒中/TIA（2.0%对0.8%，P=0.006）和死亡（2.5%对1.4%，P=0.022）的发生率更高，30天死亡率也更高（3.3%对2.0%，P=0.025）。在患有糖尿病的NSTEMI患者中，出院时分别仅有1.9%和9.0%接受了胰高血糖素样肽-1受体激动剂和钠-葡萄糖协同转运蛋白-2抑制剂的处方，仅有45.9%被转诊至心脏康复科。
与无糖尿病的NSTEMI患者相比，有糖尿病的患者临床状况更差，尽管接受了同等质量的治疗，但预后更差。开具具有心血管保护作用的降糖药物是降低进一步事件风险的一个可采取行动的目标。
