Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US.
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US.
Glob Heart. 2024 Apr 24;19(1):37. doi: 10.5334/gh.1290. eCollection 2024.
Despite cardiovascular disease being the leading cause of death in India, limited data exist regarding the factors associated with outcomes in patients with diabetes who suffer acute myocardial infarction (AMI).
We examined 21,374 patients with AMI enrolled in the ACS QUIK trial. We compared in-hospital and 30-day major adverse cardiac events including death, re-infarction, stroke, or major bleeding in those with and without diabetes. The associations between diabetes and cardiac outcomes were adjusted for presentation and in-hospital management using logistic regression.
Mean ± SD age was 60.1 ± 12.0 years, 24.3% were females, and 44.4% had diabetes. Those with diabetes were more likely to be older, female, hypertensive, and have higher Killip class but less likely to present with STEMI. Patients with diabetes had longer symptoms onset-to-arrival (median 225 vs 290 min; P < 0.001) and, in case of STEMI, longer door-to-balloon times (median, 75 vs 91 min; P < 0.001). Diabetes was independently associated with higher in-hospital death (adjusted odds ratio [aOR], 1.46; 95% CI, 1.12-1.89), in-hospital reinfarction (aOR, 1.52; 95% CI, 1.15-2.02), 30-day MACE (aOR, 1.33; 95% CI, 1.14-1.55) and 30-day death (aOR, 1.40; 95%CI, 1.16-1.69) but not 30-day stroke or 30-day major bleeding.
Among patients presenting with AMI in Kerala, India, a considerable proportion has diabetes and are at increased risk for in-hospital and 30-day adverse cardiovascular outcomes. Increased awareness of the increased cardiovascular risk and attention to the implementation of established cardiovascular therapies are indicated for patients with diabetes in lower-middle-income countries who develop AMI.
ClinicalTrials.gov Unique identifier: NCT02256658.
尽管心血管疾病是印度的主要死亡原因，但关于糖尿病合并急性心肌梗死（AMI）患者结局相关因素的数据有限。
我们研究了 ACS QUIK 试验中纳入的 21374 例 AMI 患者。我们比较了糖尿病与非糖尿病患者的住院期间和 30 天主要不良心脏事件（包括死亡、再梗死、卒中和大出血）。使用逻辑回归对与糖尿病和心脏结局相关的因素进行调整，以反映入院时的表现和入院后的管理。
平均年龄（SD）为 60.1 ± 12.0 岁，24.3%为女性，44.4%患有糖尿病。与非糖尿病患者相比，糖尿病患者年龄更大，女性更多，高血压更多，Killip 分级更高，但 ST 段抬高型心肌梗死（STEMI）比例较低。糖尿病患者症状发作至到达医院的时间（中位数 225 分钟 vs 290 分钟；P < 0.001）更长，STEMI 患者门球时间（中位数，75 分钟 vs 91 分钟；P < 0.001）也更长。糖尿病与住院期间死亡（校正比值比 [aOR]，1.46；95%置信区间 [CI]，1.12-1.89）、住院期间再梗死（aOR，1.52；95%CI，1.15-2.02）、30 天主要不良心脏事件（aOR，1.33；95%CI，1.14-1.55）和 30 天死亡（aOR，1.40；95%CI，1.16-1.69）独立相关，但与 30 天卒中和 30 天大出血无关。
在印度喀拉拉邦出现 AMI 的患者中，相当一部分患有糖尿病，住院期间和 30 天不良心血管结局的风险增加。对于在中低收入国家发生 AMI 的糖尿病患者，应提高对心血管风险增加的认识，并关注实施已确立的心血管治疗方法。
ClinicalTrials.gov 唯一标识符：NCT02256658。
