Miettinen H, Lehto S, Salomaa V, Mähönen M, Niemelä M, Haffner S M, Pyörälä K, Tuomilehto J
Department of Medicine, University of Texas Health Science Center at San Antonio, USA.
Diabetes Care. 1998 Jan;21(1):69-75. doi: 10.2337/diacare.21.1.69.
To study diabetic and nondiabetic patients with their first myocardial infarction to determine overall 1-year mortality, out-of-hospital mortality, 28-day mortality of hospitalized patients, and 1-year mortality of 28-day survivors.
This study--based on the FINMONICA Myocardial Infarction Register, a part of the Finnish contribution to the WHO MONICA Project (World Health Organization Multinational Monitoring of Trends and Determinants of Cardiovascular Disease)--covered coronary heart disease (CHD) deaths and acute CHD events occurring during hospitalization among residents of Finland aged 25-64 years in three geographically defined areas. The study population comprised 620 diabetic and 3,445 nondiabetic patients who had their first myocardial infarction during the years 1988-1992.
The age- and area-adjusted mortality rates and hazard ratios (HRs) for diabetic versus nondiabetic patients (95% CI) were as follows: The 1-year mortality rate was 44.2% in diabetic men and 32.6% in nondiabetic men (HR, 1.38; 1.18-1.61) and 36.9% in diabetic women and 20.2% in nondiabetic women (HR, 1.86; 1.40-2.46); the out-of-hospital mortality rate was 28.3% in diabetic men and 22.4% in nondiabetic men (HR, 1.25; 1.03-1.52) and 10.4% in diabetic women and 11.0% in nondiabetic women (HR, 0.95; 0.58-1.54); the 28-day mortality rate of hospitalized patients was 14.4% in diabetic men and 8.8% in nondiabetic men (HR, 1.58; 1.15-2.18) and 21.7% in diabetic women and 7.8% in nondiabetic women (HR, 2.60; 1.71-3.95); and the 1-year mortality rate of 28-day survivors was 9.6% in diabetic men and 5.0% in nondiabetic men (HR, 1.97; 1.25-3.12) and 10.7% in diabetic women and 2.5% in nondiabetic women (HR, 4.17; 2.05-8.51).
The high mortality rate of diabetic patients after their first myocardial infarction and the high proportion of out-of-hospital deaths in this group imply that vigorous primary and secondary preventive measures should become an integral part of their medical care.
研究首次发生心肌梗死的糖尿病患者和非糖尿病患者，以确定总体1年死亡率、院外死亡率、住院患者28天死亡率以及28天幸存者的1年死亡率。
本研究基于芬兰对世界卫生组织心血管疾病趋势和决定因素多国监测项目（WHO MONICA项目）所作贡献的一部分——芬兰MONICA心肌梗死登记册，涵盖了芬兰25至64岁居民在三个地理区域住院期间发生的冠心病（CHD）死亡和急性CHD事件。研究人群包括1988年至1992年间首次发生心肌梗死的620例糖尿病患者和3445例非糖尿病患者。
糖尿病患者与非糖尿病患者经年龄和区域调整后的死亡率及风险比（HRs）（95%CI）如下：1年死亡率在糖尿病男性中为44.2%，非糖尿病男性中为32.6%（HR，1.38；1.18至1.61）；在糖尿病女性中为36.9%，非糖尿病女性中为20.2%（HR，1.86；1.40至2.46）。院外死亡率在糖尿病男性中为28.3%，非糖尿病男性中为22.4%（HR，1.25；1.03至1.52）；在糖尿病女性中为10.4%，非糖尿病女性中为11.0%（HR，0.95；0.58至1.54）。住院患者28天死亡率在糖尿病男性中为14.4%，非糖尿病男性中为8.8%（HR，1.58；1.15至2.18）；在糖尿病女性中为21.7%，非糖尿病女性中为7.8%（HR，2.60；1.71至3.95）。28天幸存者的1年死亡率在糖尿病男性中为9.6%，非糖尿病男性中为5.0%（HR，1.97；1.25至3.12）；在糖尿病女性中为10.7%，非糖尿病女性中为2.5%（HR，4.17；2.05至8.51）。
糖尿病患者首次心肌梗死后的高死亡率以及该组院外死亡的高比例意味着积极的一级和二级预防措施应成为其医疗护理的一个组成部分。
