根据是否患有2型糖尿病对接受冠状动脉造影的未选择患者的长期预后情况。

Long-term outcomes of unselected patients undergoing coronary angiography according to the presence or absence of type II diabetes mellitus.

作者信息

Steinke Philipp, Schupp Tobias, Kuhn Lasse, Abumayyaleh Mohammad, Ayoub Mohamed, Mashayekhi Kambis, Bertsch Thomas, Ayasse Niklas, Jannesari Mahboubeh, Siegel Fabian, Dürschmied Daniel, Behnes Michael, Akin Ibrahim

机构信息

Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany.

Department of Internal Medicine and Cardiology, Mediclin Heart Center Lahr, Lahr, Germany.

出版信息

Cardiovasc Revasc Med. 2024 Dec 11. doi: 10.1016/j.carrev.2024.12.001.

DOI:10.1016/j.carrev.2024.12.001

PMID:39718480

Abstract

OBJECTIVE

The study investigates long-term outcomes of unselected inpatients undergoing invasive coronary angiography (CA) with and without diabetes mellitus type II (T2DM).

BACKGROUND

Due to continual shifts in demographics and advancements in treating cardiovascular disease, there has been a notable evolution in the types of patients undergoing CA over the past decades. Comprehensive data on the extended outcomes of CA patients, both with and without concurrent T2DM, remains scarce.

METHODS

Consecutive inpatients undergoing invasive CA from 2016 to 2022 were included at one institution. The prognosis of T2DM in patients undergoing CA was investigated with regard to the risk rehospitalization for heart failure (HF), acute myocardial infarction (AMI) and coronary revascularization at 36 months of follow-up. Statistical analyses included Kaplan-Meier uni- and multivariable Cox proportional regression analyses.

RESULTS

From 2016 to 2022, 7150 patients undergoing CA were included with a prevalence of T2DM of 31.2 %. Compared to non-diabetics, patients with T2DM had a higher prevalence (78.0 % vs. 64.3 %; p = 0.001) and extent (3-vessel disease: 36.9 % vs. 23.8 %; p = 0.001) of coronary artery disease (CAD). At 36 months, patients with T2DM had a higher risk rehospitalization for worsening HF (29.0 % vs. 18.2 %; p = 0.001), AMI (9.9 % vs. 6.6 %; p = 0.001), alongside with a higher need for coronary revascularization (10.7 % vs. 7.2 %; p = 0.001) compared to patients without. Even after multivariable adjustment, the risk of rehospitalization for HF (HR = 1.229; 95 % CI 1.099-1.374; p = 0.001), AMI (HR = 1.270; 95 % CI 1.052-1.534; p = 0.013) and coronary revascularization (HR = 1.457; 95 % CI 1.213-1.751; p = 0.001) was higher in patients with T2DM. Especially in patients with left ventricular ejection fraction (LVEF) ≥ 35 %, T2DM was associated with a higher risk of AMI- (HR = 1.395, 95 % CI: 1.104 - 1.763, p = 0.005) and PCI-related rehospitalization (HR = 1.442, 95 % CI: 1.185 - 1.775, p = 0.001).

CONCLUSION

In unselected patients undergoing CA, T2DM represents an independent predictor of HF-related rehospitalization, AMI- and for PCI- at 36 months.

摘要

目的

本研究调查未选择的接受有创冠状动脉造影（CA）的住院患者（伴或不伴有2型糖尿病（T2DM））的长期预后。

背景

由于人口结构的不断变化和心血管疾病治疗的进展，在过去几十年中，接受CA的患者类型有了显著演变。关于CA患者（伴或不伴有并发T2DM）长期预后的综合数据仍然稀缺。

方法

纳入一家机构2016年至2022年连续接受有创CA的住院患者。在随访36个月时，就心力衰竭（HF）、急性心肌梗死（AMI）和冠状动脉血运重建的再住院风险，对接受CA的患者中T2DM的预后进行调查。统计分析包括Kaplan-Meier单变量和多变量Cox比例回归分析。

结果

2016年至2022年，纳入7150例接受CA的患者，T2DM患病率为31.2%。与非糖尿病患者相比，T2DM患者冠状动脉疾病（CAD）的患病率（78.0%对64.3%；p = 0.001）和病变范围（三支血管病变：36.9%对23.8%；p = 0.001）更高。在36个月时，与无T2DM的患者相比，T2DM患者因HF恶化再次住院的风险更高（29.0%对18.2%；p = 0.001），AMI（9.9%对6.6%；p = 0.001），同时冠状动脉血运重建的需求也更高（10.7%对7.2%；p = 0.001）。即使经过多变量调整，T2DM患者因HF再次住院的风险（HR = 1.229；95%CI 1.099 - 1.374；p = 0.001）、AMI（HR = 哈1.270；95%CI 1.052 - 1.534；p = 0.013）和冠状动脉血运重建（HR = 1.457；95%CI 1.213 - 1.751；p = 0.001）仍更高。特别是在左心室射血分数（LVEF）≥35%的患者中，T2DM与AMI相关（HR = 1.395，95%CI：1.104 - 1.763，p = 0.005）和PCI相关再住院风险更高（HR = 1.442，95%CI：1.185 - 1.775，p = 0.001）。