Lehto S, Pyörälä K, Miettinen H, Rönnemaa T, Palomäki P, Tuomilehto J, Laakso M
Department of Medicine, Kuopio University Hospital, Finland.
J Intern Med. 1994 Sep;236(3):291-7. doi: 10.1111/j.1365-2796.1994.tb00799.x.
To study the infarct size and mortality in patients with non-insulin-dependent diabetes mellitus (NIDDM) and in non-diabetic subjects with their first acute myocardial infarction.
Seven year follow-up study of large representative cohorts of patients with non-insulin-dependent diabetes mellitus and non-diabetic subjects (study 1) and the FINMONICA acute myocardial infarction register study in 1988-89 (study 2).
Populations of the districts of the Kuopio University Hospital and Turku University Central Hospital (study 1). Populations of Kuopio and North Karelia provinces and Turku/Loimaa area (study 2).
Study 1: 1059 patients with non-insulin dependent diabetes mellitus and 1373 non-diabetic subjects aged 45-64 years at baseline; during the follow-up 166 patients with non-insulin-dependent diabetes mellitus (91 men and 75 women) and 30 non-diabetic subjects (25 men and five women) were hospitalized for their first acute myocardial infarction. Study 2: 1622 patients aged 25-64 years hospitalized for their first acute myocardial infarction; 144 patients (90 men and 54 women) had non-insulin-dependent diabetes mellitus and 1153 (890 men and 263 women) were non-diabetic.
The infarct size was assessed on the basis of maximum levels of serum cardiac enzymes (studies 1 and 2) and QRS-score (study 1).
No differences were found in maximum levels of serum cardiac enzymes between diabetic and non-diabetic patients. Similarly QRS-score gave no suggestion of a difference in infarct size between diabetic and non-diabetic patients. In both studies mortality before hospital admission was similar in diabetic and non-diabetic patients, but mortality within 28 days from hospital admission was twice as high in diabetic patients as in non-diabetic patients. Cardiac failure was the main cause of death significantly more often in diabetic patients than in non-diabetic patients (study 2).
Poorer prognosis of acute myocardial infarction in diabetic patients appears not to be explained by a larger infarct size but probably by adverse effects of the diabetic state itself on myocardial function.
研究非胰岛素依赖型糖尿病（NIDDM）患者及首次发生急性心肌梗死的非糖尿病患者的梗死面积和死亡率。
对非胰岛素依赖型糖尿病患者和非糖尿病患者的大型代表性队列进行七年随访研究（研究1），以及1988 - 1989年的芬兰MONICA急性心肌梗死登记研究（研究2）。
库奥皮奥大学医院和图尔库大学中心医院所在地区的人群（研究1）。库奥皮奥和北卡累利阿省以及图尔库/洛马阿地区的人群（研究2）。
研究1：基线时1059例非胰岛素依赖型糖尿病患者和1373例45 - 64岁的非糖尿病患者；随访期间，166例非胰岛素依赖型糖尿病患者（91例男性和75例女性）和30例非糖尿病患者（25例男性和5例女性）因首次急性心肌梗死住院。研究2：1622例25 - 64岁因首次急性心肌梗死住院的患者；144例（90例男性和54例女性）患有非胰岛素依赖型糖尿病，1153例（890例男性和263例女性）为非糖尿病患者。
根据血清心肌酶的最高水平（研究1和2）和QRS评分（研究1）评估梗死面积。
糖尿病患者和非糖尿病患者的血清心肌酶最高水平未发现差异。同样，QRS评分也未提示糖尿病患者和非糖尿病患者在梗死面积上存在差异。在两项研究中，糖尿病患者和非糖尿病患者入院前的死亡率相似，但入院后28天内糖尿病患者的死亡率是非糖尿病患者的两倍。糖尿病患者中心力衰竭作为主要死亡原因的情况明显多于非糖尿病患者（研究2）。
糖尿病患者急性心肌梗死预后较差似乎并非由梗死面积较大所致，而可能是糖尿病状态本身对心肌功能的不良影响。
