老年急性心肌梗死患者入院时急性血糖参数与心血管死亡率的相关性

Association of acute glycemic parameters at admission with cardiovascular mortality in the oldest old with acute myocardial infarction.

作者信息

Liu Hui-Hui, Zhang Meng, Guo Yuan-Lin, Zhu Cheng-Gang, Wu Na-Qiong, Gao Ying, Xu Rui-Xia, Qian Jie, Dou Ke-Fei, Li Jian-Jun

机构信息

Cardiometabolic Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

J Geriatr Cardiol. 2024 Mar 28;21(3):349-358. doi: 10.26599/1671-5411.2024.03.008.

DOI:10.26599/1671-5411.2024.03.008

PMID:38665285

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11040058/

Abstract

OBJECTIVES

Stress-related glycemic indicators, including admission blood glucose (ABG), stress-hyperglycemia ratio (SHR), and glycemic gap (GG), have been associated with worse outcomes after acute myocardial infarction (AMI). However, data regarding their prognostic value in the oldest old with AMI are unavailable. Therefore, this study aimed to investigate the association of stress-related glycemic indicators with short- and long-term cardiovascular mortality (CVM) in the oldest old (≥ 80 years) with AMI.

METHODS

In this prospective study, a total of 933 consecutive old patients with AMI admitted to FuWai hospital (Beijing, China) were enrolled. On admission, ABG, SHR, and GG were assessed and all participants were classified according to their quartiles. Kaplan-Meier, restricted cubic splines (RCS), and multivariate Cox regression analyses were performed to evaluate the association between these glycemic indicators and CVM within 30 days and long-term follow-up.

RESULTS

During an average of 1954 patient-years of follow-up, a total of 250 cardiovascular deaths were recorded. Kaplan-Meier analyses showed the lowest CVM in quartile 1 of ABG and in quartile 2 of SHR and GG. After adjusting for potential covariates, patients in quartile 4 of ABG, SHR, and GG had a respective 1.67-fold (95% CI: 1.03-2.69; = 0.036), 1.80-fold (95% CI: 1.16-2.79; = 0.009), and 1.78-fold (95% CI: 1.14-2.79; = 0.011) higher risk of long-term CVM risk compared to those in the reference groups (quartile 1 of ABG and quartile 2 of SHR and GG). Furthermore, RCS suggested a J-shaped relationship of ABG and a U-shaped association of SHR and GG with long-term CVM. Additionally, we observed similar associations of these acute glycemic parameters with 30-day CVM.

CONCLUSIONS

Our data first indicated that SHR and GG consistently had a U-shaped association with both 30-day and long-term CVM among the oldest old with AMI, suggesting that they may be useful for risk stratification in this special population.

摘要

目的

应激相关血糖指标，包括入院血糖（ABG）、应激性高血糖比率（SHR）和血糖差值（GG），已被证实与急性心肌梗死（AMI）后更差的预后相关。然而，关于这些指标在高龄AMI患者中的预后价值的数据尚不可得。因此，本研究旨在探讨应激相关血糖指标与高龄（≥80岁）AMI患者短期和长期心血管死亡率（CVM）之间的关联。

方法

在这项前瞻性研究中，共纳入了933例连续入住中国北京阜外医院的老年AMI患者。入院时，评估ABG、SHR和GG，并根据四分位数对所有参与者进行分类。采用Kaplan-Meier分析、限制性立方样条（RCS）分析和多变量Cox回归分析来评估这些血糖指标与30天内及长期随访期间CVM之间的关联。

结果

在平均1954患者年的随访期间，共记录了250例心血管死亡病例。Kaplan-Meier分析显示，ABG的第一四分位数以及SHR和GG的第二四分位数的CVM最低。在调整潜在协变量后，ABG、SHR和GG的第四四分位数的患者与参考组（ABG的第一四分位数以及SHR和GG的第二四分位数）相比，长期CVM风险分别高1.67倍（95%CI：1.03-2.69；P=0.036）、1.80倍（95%CI：1.16-2.79；P=0.009）和1.78倍（95%CI：1.14-2.79；P=0.011）。此外，RCS表明ABG与长期CVM呈J形关系，SHR和GG与长期CVM呈U形关系。此外，我们观察到这些急性血糖参数与30天CVM之间存在类似的关联。