血浆糖化血红蛋白A1c所反映的基线血糖控制对冠心病合并2型糖尿病患者不良结局的影响：PROMISE研究结果

Implications of baseline glycemic control by plasma glycated hemoglobin A1c on adverse outcomes in patients with coronary heart disease and type 2 diabetes mellitus: Results from the PROMISE study.

作者信息

Tang Xiao-Fang, Li Qin-Xue, Han Ya-Ling, Wang Xiao-Zeng, Song Ying, Zhang Zheng, Xu Jing-Jing, Liu Zhen-Yu, Chen Yan, Zhang Yong-Zhen, Zhu Pei, Guo Xiao-Gang, Jiang Lin, Wang Zhi-Fang, Liu Ru, Wang Qing-Sheng, Yao Yi, Feng Ying-Qing, Zhao Xue-Yan, Yuan Jin-Qing

机构信息

Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China.

出版信息

Heliyon. 2024 Oct 23;10(22):e39748. doi: 10.1016/j.heliyon.2024.e39748. eCollection 2024 Nov 30.

DOI:10.1016/j.heliyon.2024.e39748

PMID:39584103

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11585765/

Abstract

BACKGROUND

The optimal glycosylated hemoglobin (HbA1c) target in type 2 diabetes mellitus (T2DM) patients remains controversial, especially in patients with concomitant coronary heart disease (CHD). This study aimed to investigate the correlation between baseline HbA1c and long-term prognosis in CHD patients with T2DM.

METHODS

The study enrolled 6,839 CHD patients with T2DM and measured HbA1c at admission in a multicenter prospective observational cohort. Patients were divided into two groups according to baseline HbA1c levels: optimal glycemic control group (HbA1c < 7.0 %, n = 3023) and poor glycemic control group (HbA1c ≥ 7.0 %, n = 3816). The study endpoints were all-cause death and major adverse cardiac and cerebrovascular events (MACCEs).

RESULTS

The median follow-up period was 2.1 years. During this period, 229 (3.3 %) all-cause deaths, 165 (2.4 %) cardiac deaths, and 759 (11.1 %) MACCEs occurred. Unadjusted Kaplan-Meier analysis showed that the incidences of all-cause death, cardiac death, non-fatal MI, unplanned revascularization, and MACCEs were significantly lower in the HbA1c < 7.0 % group than in the HbA1c ≥ 7.0 % group (P < 0.05). Multivariate Cox hazard analysis indicated that the incidences of all-cause death, cardiac death and MACCEs were significantly lower in the HbA1c < 7.0 % group compared to the HbA1c ≥ 7.0 % group [all-cause death: hazard ratio (HR) 1.969, 95 % confidence interval (CI) 1.421-2.729; cardiac death: HR 2.515, 95 % CI 1.647-3.839; MACCEs: HR 1.345, 95 % CI 1.150-1.573; P < 0.001].

CONCLUSIONS

Baseline HbA1c level was associated with all-cause death, cardiac death, and MACCEs in CHD patients with T2DM.

摘要

背景

2型糖尿病（T2DM）患者的最佳糖化血红蛋白（HbA1c）目标仍存在争议，尤其是在合并冠心病（CHD）的患者中。本研究旨在探讨T2DM合并CHD患者基线HbA1c与长期预后之间的相关性。

方法

本研究纳入了6839例T2DM合并CHD患者，并在多中心前瞻性观察队列中于入院时测定了HbA1c。根据基线HbA1c水平将患者分为两组：血糖控制理想组（HbA1c < 7.0%，n = 3023）和血糖控制不佳组（HbA1c≥7.0%，n = 3816）。研究终点为全因死亡和主要不良心脑血管事件（MACCEs）。

结果

中位随访期为2.1年。在此期间，发生了229例（3.3%）全因死亡、165例（2.4%）心源性死亡和759例（11.1%）MACCEs。未校正的Kaplan-Meier分析显示，HbA1c < 7.0%组的全因死亡、心源性死亡、非致命性心肌梗死、非计划性血运重建和MACCEs的发生率显著低于HbA1c≥7.0%组（P < 0.05）。多因素Cox风险分析表明，与HbA1c≥7.0%组相比，HbA1c < 7.0%组的全因死亡、心源性死亡和MACCEs的发生率显著更低[全因死亡：风险比（HR）1.969，95%置信区间（CI）1.421 - 2.729；心源性死亡：HR 2.515，95% CI 1.647 - 3.839；MACCEs：HR 1.345，95% CI 1.150 - 1.573；P < 0.001]。