Boxhammer Elke, Hammerer Matthias, Schernthaner Christiana, Prinz Erika, Brandt Mathias C, Lichtenauer Michael, Berezin Alexander E, Wintersteller Wilfried, Hoppe Uta C, Kopp Kristen L
Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria.
Biomedicines. 2024 Sep 29;12(10):2223. doi: 10.3390/biomedicines12102223.
Prediabetes is frequently underdiagnosed and undertreated, yet it poses significant cardiovascular risks. This study investigates the impact of prediabetes on short- and long-term survival outcomes in patients who experienced ST-elevation myocardial infarction (STEMI). In this retrospective, single-center cohort study, we evaluated 725 STEMI patients stratified into non-diabetic, prediabetic, and diabetic groups based on HbA1c levels at presentation. A Kaplan-Meier survival analysis was employed to compare long-term outcomes over a three-year follow-up period. Cardiovascular risk factors, including hypertension and dyslipidemia, were analyzed across the groups. The discriminatory power of HbA1c for predicting all-cause mortality was assessed using an Area Under the Receiver Operating Characteristic (AUROC) analysis. : Of the 725 patients, 407 (56.1%) were non-diabetic, 184 (25.4%) were prediabetic, and 134 (18.5%) were diabetic. Prediabetic patients exhibited significant additional cardiovascular risk factors, such as arterial hypertension (67.4%) and dyslipidemia (78.3%), with prevalence rates between those of non-diabetic and diabetic patients. The Kaplan-Meier analysis revealed that at a three-year follow-up, prediabetic patients faced a survival disadvantage, with a significant decrease in survival rates compared to non-diabetic patients (log-rank = 0.016); their survival outcomes approached those of diabetic patients ( = 0.125). The AUROC analysis demonstrated that HbA1c was a significant predictor of short- and long-term mortality, with a cut-off value of 5.75% and an Area Under the Curve (AUC) of 0.580-0.617 (95% CI: 0.458-0.721), indicating a moderate ability to predict survival in patients with STEMI. Prediabetes significantly worsens survival outcomes following STEMI, nearly approaching the risk level of diabetes. Integrating rigorous cardiovascular risk management strategies for prediabetic individuals, including lifestyle interventions and potentially pharmacological treatments, could prevent the progression to diabetes and mitigate associated cardiovascular risks.
糖尿病前期常常未得到充分诊断和治疗，但其会带来重大的心血管风险。本研究调查了糖尿病前期对发生ST段抬高型心肌梗死（STEMI）患者短期和长期生存结局的影响。在这项回顾性单中心队列研究中，我们根据就诊时的糖化血红蛋白（HbA1c）水平，将725例STEMI患者分为非糖尿病组、糖尿病前期组和糖尿病组。采用Kaplan-Meier生存分析比较三年随访期内的长期结局。对各组的心血管危险因素，包括高血压和血脂异常进行了分析。使用受试者工作特征曲线下面积（AUROC）分析评估HbA1c预测全因死亡率的鉴别能力。725例患者中，407例（56.1%）为非糖尿病患者，184例（25.4%）为糖尿病前期患者，134例（18.5%）为糖尿病患者。糖尿病前期患者表现出显著的额外心血管危险因素，如动脉高血压（67.4%）和血脂异常（78.3%），其患病率介于非糖尿病患者和糖尿病患者之间。Kaplan-Meier分析显示，在三年随访时，糖尿病前期患者面临生存劣势，与非糖尿病患者相比生存率显著降低（对数秩检验=0.016）；其生存结局接近糖尿病患者（=0.125）。AUROC分析表明，HbA1c是短期和长期死亡率的重要预测指标，截断值为5.75%，曲线下面积（AUC）为0.580 - 0.617（95%可信区间：0.458 - 0.721），表明其预测STEMI患者生存的能力中等。糖尿病前期显著恶化STEMI后的生存结局，几乎接近糖尿病的风险水平。为糖尿病前期个体整合严格的心血管风险管理策略，包括生活方式干预以及可能的药物治疗，可预防进展为糖尿病并减轻相关心血管风险。
