Gowda M S, Vacek J L, Hallas D
University of Missouri-Kansas City, and Mid-America Heart Institute, St. Lukes Hospital of Kansas City, USA.
Am J Cardiol. 1998 May 1;81(9):1067-71. doi: 10.1016/s0002-9149(98)00117-9.
Risk factors and outcomes associated with non-Q-wave myocardial infarction (MI) in diabetics and nondiabetics were analyzed for 376 consecutive patients, 77 with diabetes (20%) and 299 nondiabetics (80%), who had non-Q-wave MI and had percutaneous transluminal coronary angioplasty (PTCA) performed before discharge from hospital during the period from January 1992 to February 1996. Diabetics were slightly older (64 +/- 10 years vs 61 +/- 12 years, p <0.053), had more prior coronary artery bypass grafting (CABG) surgery (27% vs 12%, p <0.001), and hypertension (77% vs 49%, p <0.001). There was no significant difference in unstable angina, saphenous vein graft PTCA, single versus multiple vessel disease, or history of MI. PTCA success rates for diabetics versus nondiabetics were similar (96% vs 97%, p = NS). In-hospital complications such CABG, recurrent MI, repeat PTCA, stroke, and death were not statistically significant between the 2 groups. At 1-year follow-up, survival in diabetics (92%) was similar to nondiabetics (94%, p = NS), although event-free survival (PTCA, CABG, MI, death) was worse in diabetics (55% vs 67% for nondiabetics, p <0.05). Although diabetic patients with non-Q-wave MI represent a cohort with more risk factors for poor outcome, aggressive in-hospital revascularization with PTCA results in an excellent short-term outcome as well as 1-year survival similar to the nondiabetic patients. However, total events at 1-year follow-up are more common in the diabetic patients, suggesting that more aggressive screening and therapy in follow-up may be warranted, and that a diabetic with non-Q-wave MI will require increased utilization of cardiovascular resources in the first year after the event.
对1992年1月至1996年2月期间连续收治的376例非Q波心肌梗死（MI）患者进行了分析，其中77例（20%）为糖尿病患者，299例（80%）为非糖尿病患者，这些患者均患有非Q波MI且在出院前接受了经皮腔内冠状动脉成形术（PTCA）。糖尿病患者年龄稍大（64±10岁 vs 61±12岁，p<0.053），既往冠状动脉旁路移植术（CABG）手术史更多（27% vs 12%，p<0.001），高血压患病率更高（77% vs 49%，p<0.001）。不稳定型心绞痛、大隐静脉移植PTCA、单支血管病变与多支血管病变或MI病史方面无显著差异。糖尿病患者与非糖尿病患者的PTCA成功率相似（96% vs 97%，p=无统计学意义）。两组间CABG、再发MI、重复PTCA、中风和死亡等院内并发症无统计学差异。在1年随访时，糖尿病患者的生存率（92%）与非糖尿病患者相似（94%，p=无统计学意义），尽管糖尿病患者的无事件生存率（PTCA、CABG、MI、死亡）较差（55% vs 非糖尿病患者的67%，p<0.05）。尽管非Q波MI的糖尿病患者代表了一组预后不良风险因素更多的人群，但通过PTCA进行积极的院内血管重建可带来良好的短期预后以及与非糖尿病患者相似的1年生存率。然而，糖尿病患者在1年随访时的总事件更常见，这表明在随访中可能需要更积极的筛查和治疗，并且非Q波MI的糖尿病患者在事件发生后的第一年将需要更多地利用心血管资源。
