Mak K H, Moliterno D J, Granger C B, Miller D P, White H D, Wilcox R G, Califf R M, Topol E J
Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA.
J Am Coll Cardiol. 1997 Jul;30(1):171-9. doi: 10.1016/s0735-1097(97)00118-6.
This study was undertaken to define and better understand the characteristics and outcomes of patients with diabetes treated for acute myocardial infarction with contemporary thrombolysis.
Although thrombolysis has substantially improved survival of patients with myocardial infarction, diabetes mellitus remains an independent predictor for a poor prognosis.
We characterized the contemporary relation between diabetes and outcome after myocardial infarction treated with thrombolytic agents from a large international cohort. Of 41,021 patients randomized to receive accelerated tissue-type plasminogen activator (t-PA), streptokinase or a combination of both agents in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries study, there were 5,944 patients with diabetes and 34,888 patients without diabetes.
Patients with diabetes were older and more likely to be female, to present with anterior wall infarction, to receive thrombolysis later and to have triple-vessel coronary artery disease. Mortality at 30 days was highest among diabetic patients treated with insulin (12.5%) compared with non-insulin-treated diabetic (9.7%) and nondiabetic (6.2%) patients (p < 0.001). Mortality was lowest among those with diabetes receiving accelerated t-PA, which is consistent with the results of the overall patient cohort. Although stroke occurred more frequently among diabetic (1.9%) than nondiabetic patients (1.4%, p < 0.001), there was no significant difference in the rates of intracranial hemorrhage. Cardiac failure, shock, atrioventricular block and atrial flutter/ fibrillation were more common among diabetic patients. The proportion of patients undergoing revascularization was similar between patients with and without diabetes, although diabetic patients were more likely to undergo coronary artery bypass graft surgery (10.4% vs. 8.3%). Diabetes remained an independent predictor for mortality at 1-year follow-up (14.5% vs. 8.9%, p < 0.001).
Diabetes, alone and in association with its comorbidities, portends a substantially worse 30-day and 1-year prognosis for patients with myocardial infarction.
开展本研究以明确并更好地了解接受当代溶栓治疗的急性心肌梗死糖尿病患者的特征及预后。
尽管溶栓治疗已显著提高心肌梗死患者的生存率，但糖尿病仍然是预后不良的独立预测因素。
我们从一个大型国际队列中分析了糖尿病与接受溶栓治疗的心肌梗死后预后之间的当代关系。在全球应用链激酶和组织型纤溶酶原激活剂治疗闭塞冠状动脉研究中，41021例随机接受加速组织型纤溶酶原激活剂（t-PA）、链激酶或两者联合治疗的患者中，有5944例糖尿病患者和34888例非糖尿病患者。
糖尿病患者年龄更大，更可能为女性，更易出现前壁梗死，溶栓治疗时间更晚，且更易患有三支冠状动脉疾病。与未接受胰岛素治疗的糖尿病患者（9.7%）和非糖尿病患者（6.2%）相比，接受胰岛素治疗的糖尿病患者30天死亡率最高（12.5%）（p<0.001）。接受加速t-PA治疗的糖尿病患者死亡率最低，这与总体患者队列的结果一致。尽管糖尿病患者中风发生率（1.9%）高于非糖尿病患者（1.4%，p<0.001），但颅内出血发生率无显著差异。心力衰竭、休克、房室传导阻滞和心房扑动/颤动在糖尿病患者中更为常见。糖尿病患者和非糖尿病患者接受血运重建的比例相似，尽管糖尿病患者更可能接受冠状动脉搭桥手术（10.4%对8.3%）。在1年随访中，糖尿病仍然是死亡率的独立预测因素（14.5%对8.9%，p<0.001）。
糖尿病及其合并症会使心肌梗死患者的30天和1年预后显著更差。
