Granger C B, Califf R M, Young S, Candela R, Samaha J, Worley S, Kereiakes D J, Topol E J
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
J Am Coll Cardiol. 1993 Mar 15;21(4):920-5. doi: 10.1016/0735-1097(93)90348-5.
This study was designed to assess outcome in patients with diabetes who received thrombolytic therapy and to determine whether differences in angiographic characteristics may account for the worse outcome observed in diabetic patients.
Patients with diabetes are known to have a worse outcome after acute myocardial infarction than that of patients without diabetes.
Clinical and angiographic characteristics of the 148 patients with diabetes and the 923 patients without diabetes in the Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) trials were examined and analyzed.
Patients with diabetes tended to be older (median age 59 vs. 56 years) and to have a higher incidence of hypertension and hyperlipidemia and a lower incidence of cigarette smoking. Patients with diabetes had significantly more severe anatomic disease (66% vs. 46% had multivessel disease, p < 0.0001), similar global left ventricular ejection fraction (49% vs. 51%) and worse noninfarct zone ventricular function (-0.13 vs. 0.32 SD/chord, p = 0.02) than that of nondiabetic patients. Angiographic patency rates at 90 min after thrombolytic therapy were similar in patients with and without diabetes (initial 90-min patency 71% vs. 70%). Diabetic patients had nearly twice the in-hospital mortality rate (11% vs. 6%, p < 0.02) and a higher incidence of pulmonary edema (11% vs. 4%, p = 0.001). Diabetic women had an especially high in-hospital mortality rate (21%). No retinal hemorrhages were observed. Although diabetes as an unadjusted variable was predictive of in-hospital (p < 0.02) and long-term (p = 0.003) mortality, after adjustment for baseline clinical and angiographic characteristics, diabetes was not found to have an independent influence on mortality.
Patients with diabetes after myocardial infarction have a worse outcome than that of patients without diabetes despite similar rates of infarct vessel patency. However, diabetes was not found to be an independent risk factor for increased mortality. These findings suggest that diabetes itself is not a major risk factor for poor early outcome after thrombolytic therapy for myocardial infarction; rather, the secondary effects such as more extensive coronary artery disease account for the worse outcome.
本研究旨在评估接受溶栓治疗的糖尿病患者的预后，并确定血管造影特征的差异是否可以解释糖尿病患者观察到的较差预后。
已知糖尿病患者急性心肌梗死后的预后比非糖尿病患者差。
对心肌梗死溶栓和血管成形术（TAMI）试验中的148例糖尿病患者和923例非糖尿病患者的临床和血管造影特征进行了检查和分析。
糖尿病患者往往年龄较大（中位年龄59岁对56岁），高血压和高脂血症的发生率较高，吸烟率较低。糖尿病患者的解剖学疾病明显更严重（66%对46%有多支血管病变，p<0.0001），总体左心室射血分数相似（49%对51%），非梗死区心室功能比非糖尿病患者差（-0.13对0.32标准差/弦，p=0.02）。溶栓治疗后90分钟时的血管造影通畅率在糖尿病患者和非糖尿病患者中相似（初始90分钟通畅率71%对70%）。糖尿病患者的住院死亡率几乎是非糖尿病患者的两倍（11%对6%，p<0.02），肺水肿发生率较高（11%对4%，p=0.001）。糖尿病女性的住院死亡率特别高（21%）。未观察到视网膜出血。尽管糖尿病作为一个未调整的变量可预测住院（p<0.02）和长期（p=0.0
