急性非糖尿病心肌梗死病人中糖尿病前期与心脏主要不良事件的相关性分析

目的 探讨非糖尿病(non-DM)的急性心肌梗死(AMI)病人中糖尿病前期(pre-DM)与预后的关系.方法 回顾性分析1 332例non-DM的AMI病人,根据糖化血红蛋白水平分为两组,pre-DM组(5.7%~6.4%)783例和non-DM组(<5.7%)549例,平均随访25.6月,以单因素和多因素分析法评估pre-DM与随访期间心脏主要不良事件(MACE)的关系.结果 pre-DM组病人较non-DM组年龄更大、心功能更差、血糖更高,但住院死亡率两组间差异无统计学意义(OR=1.37,95%CI:0.74~2.54,P=0.309).随访期间pre-DM组33.97%发生MACE事件,明显高于non-DM组的27.87,%,差异有统计学意义(OR=1.33,95%CI:1.05~1.69,P=0.018).全因死亡、非致死性心梗及再住院,两组间差异无统计学意义.多因素回归模型提示pre-DM是随访期间MACE事件的独立危险因素(OR=1.15,95%CI:1.03~1.68,P=0.029).结论 在non-DM的AMI人群中,pre-DM与较高MACE发生率相关.临床中应对AMI病人常规筛查糖化血红蛋白.

Association of prediabetes with major adverse cardiac events inpatients with acute myocardial infarction

Objective To evaluate the prognostic value of prediabetes (pre-DM) in nondiabetic patients with acute myocardial infarction (AMI).Methods We retrospectively included 1 332 AMI patients without known DM,who were assigned to pre-DM group (5.7%-6.4%,n=783) or non-DM group (<5.7%,n=549) according to HbA1c levels.The patients were followed up for an average of 25.6 months and univariate and multivariate analyses were employed to assess the association between pre-DM and major adverse cardiac events (MACE) during follow-up.Results Patients in pre-DM group were older,with worse heart function and higher glucose,but had similar in-hospital mortality when compared with patients in non-DM group (OR=1.37,95%CI:0.74-2.54, P=0.309).During the follow-up,33.97% patients in pre-DM group developed MACEs,which was significantly higher than in non-DM group (OR=1.33,95%CI:1.05-1.69, P=0.018).However,we failed to detect the difference between pre-DM group and non-DM group in all-cause mortality,non-fatal infarction and readmission.Multivariate model showed that pre-DM was an independent risk factor of MACE during follow-up (OR=1.15,95%CI:1.03-1.68, P=0.029).Conclusions In AMI patients without known DM,pre-DM was associated with higher incidence of MACE.Measurement of HbA1c might be useful in clinics for nondiabetic patients with AMI.