摘要
Background Several studies have reported an association of hyperglycemia with increased mortality and complications in hospital patients with acute coronary syndrome （ACS）. However, the influence of stress hyperglycemia （SH） on the medium- and long-term prognoses in ACS patients has not yet been determined. Methods Random venous blood glucose levels were determined in 433 ACS patients and the patients were divided into two groups based on blood glucose results and disease histories. The 171 patients included in the experimental group had no history of diabetes, had no diabetes and/or glucose metabolism disorders during hospitalization and follow-up and had fasting blood glucose levels of I〉 7.0 mmol/L and random blood glucose levels 1〉 11.1 mmol/L. The 262 patients included in the control group had no history of diabetes, had no diabetes and/or glucose metabolism disorders during hospitalization and follow-up, and had fasting blood glucose levels 〈 6.1 mmoL/L and random blood glucose levels 〈 7.8 mmol/L. Basic clinical information, coronary angiographic lesion characteristics, PCI success rate, complication rate, incidence and morbidity rate of cardiovascular events during the hospitalization period and 6 years of follow-up were compared between the two groups. Results There was no significant difference in age, gender or disease history between the two groups. The triglyceride levels and the left ventricular ejection fractions were significantly higher （P = 0.00） and significantly lower （P = 0.03） in the experimental group than in the control group, respectively. Both groups were subjected to coronary angiography and PCI. The PCI success rates of the two groups did not differ significantly （P = 0.63）. The experimental group had more type B2 lesions, but fewer type A lesions compared with the control group. The experimental group had significantly more stents implanted compared with the control group （P 〈 0.05）. The cardiovascular events were significantly increased （P = 0.01） in the experimental group compared with the control group 1 year after discharge. The incidence of cardiovascular events did not differ significantly between the two groups 1-2 years after discharge. The event incidences were significantly higher （P -- 0.05） in the experimental group than in the control group at the end of follow-up. The experimental group was more prone to myocardial infarction and ischemic target vessel revascularization than the control group, but the control group was more prone to unstable stenocardia and heart failure than the experimental group. The psychogenic mortality of the two groups were similar. The interval and the overall mortality rates （P = 0.054） of the two groups were also similar. Conclusions Patients with ACS complicated by SH were more likely to have cardiovascular events 1 year after PCI, whereas SH did not affect the mid- or long-term prognoses of these patients. SH is an independent risk factor for cardiovascular events.
Background Several studies have reported an association of hyperglycemia with increased mortality and complications in hospital patients with acute coronary syndrome （ACS）. However, the influence of stress hyperglycemia （SH） on the medium- and long-term prognoses in ACS patients has not yet been determined. Methods Random venous blood glucose levels were determined in 433 ACS patients and the patients were divided into two groups based on blood glucose results and disease histories. The 171 patients included in the experimental group had no history of diabetes, had no diabetes and/or glucose metabolism disorders during hospitalization and follow-up and had fasting blood glucose levels of I〉 7.0 mmol/L and random blood glucose levels 1〉 11.1 mmol/L. The 262 patients included in the control group had no history of diabetes, had no diabetes and/or glucose metabolism disorders during hospitalization and follow-up, and had fasting blood glucose levels 〈 6.1 mmoL/L and random blood glucose levels 〈 7.8 mmol/L. Basic clinical information, coronary angiographic lesion characteristics, PCI success rate, complication rate, incidence and morbidity rate of cardiovascular events during the hospitalization period and 6 years of follow-up were compared between the two groups. Results There was no significant difference in age, gender or disease history between the two groups. The triglyceride levels and the left ventricular ejection fractions were significantly higher （P = 0.00） and significantly lower （P = 0.03） in the experimental group than in the control group, respectively. Both groups were subjected to coronary angiography and PCI. The PCI success rates of the two groups did not differ significantly （P = 0.63）. The experimental group had more type B2 lesions, but fewer type A lesions compared with the control group. The experimental group had significantly more stents implanted compared with the control group （P 〈 0.05）. The cardiovascular events were significantly increased （P = 0.01） in the experimental group compared with the control group 1 year after discharge. The incidence of cardiovascular events did not differ significantly between the two groups 1-2 years after discharge. The event incidences were significantly higher （P -- 0.05） in the experimental group than in the control group at the end of follow-up. The experimental group was more prone to myocardial infarction and ischemic target vessel revascularization than the control group, but the control group was more prone to unstable stenocardia and heart failure than the experimental group. The psychogenic mortality of the two groups were similar. The interval and the overall mortality rates （P = 0.054） of the two groups were also similar. Conclusions Patients with ACS complicated by SH were more likely to have cardiovascular events 1 year after PCI, whereas SH did not affect the mid- or long-term prognoses of these patients. SH is an independent risk factor for cardiovascular events.
基金
supported by Medical Scientific Research Foundation of Guangdong Province,China(No.B2013401)
