糖尿病对急性心肌梗死患者直接经皮冠状动脉介入治疗后左心室重构的影响

The influence of diabetes on left ventricular remodeling after primary percutaneous coronary intervention for patients with acute myocardial infarction

目的心肌梗死后左心室重构与患者的临床预后密切相关,本研究旨在探讨糖尿病对急性ST段抬高心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)后左心室重构的影响。方法单中心、前瞻性入选STEMI接受急诊PCI的患者451例,其中糖尿病患者93例,非糖尿病患者358例。比较糖尿病组与非糖尿病组患者的一般临床情况、造影和介入治疗结果、术后1周和6个月心超随访左心室重构及不良心脏事件发生率。结果与非糖尿病组比较,糖尿病组患者症状至就诊时间显著延长[(399±106)min比(321±116)min,P=0.006],多支血管病变比例增高(65.6%比51.7%,P=0.02),但两组住院期左心功能相似。PCI后6个月心超随访发现,糖尿病组患者左心室重构比例明显高于非糖尿病患者(29.0%比17.3%,P=0.01)。糖尿病(RR 2.10,95%CI 1.31-4.79,P=0.02)、前壁心肌梗死(RR 2.13,95%CI 1.31-4.19,P=0.03)及多支血管病变(RR 2.85,95%CI1.73-4.67,P=0.01)是STEMI患者发生左心室重构的独立预测因素。临床随访显示,糖尿病组患者因心力衰竭诊断而再次住院的比例增加(12.9%比8.1%,P=0.15)。左心室重构患者(23/89例)发生不良临床事件比例显著高于无左心室重构患者(25.8%比6.6%,P<0.001)。结论糖尿病是急性STEMI患者急诊PCI后发生左心室重构的高危因素,因此,制定糖尿病STEMI患者的综合干预策略,可能有助于进一步改善其预后。

Objective To investigate the influence of diabetes mellitus （DM） on left ventricular（LV） remodeling in patients with acute ST-segment elevation myocardial infarction （STEMI） treated by primary percutaneous coronary intervention （PCI） within 12 hours of symptom onset. Methods Four hundred and fifty-one consecutive patients with acute STEMI treated by primary PCI were prospectively enrolled in the current study. Baseline, angiographic and PCI features and prevalence of LV remodeling at one-week during hospitalization and 6-month clinical follow-up by two-dimensional echocardiography were compared between 93 diabetic and 358 non-diabetic patients. Results Despitenbsp;similar baseline clinical and angiographic characteristics, symptom-to-door time was longer （399±106 min vs. 321±116 min, P=0.006） and prevalence of multivessel disease was higher （65.6%vs. 51.7%, P=0.02） in diabetic patients. More patients in diabetic group had LV remodeling at 6-month clinical follow-up （29.0%vs. 17.3%, P=0.01）, and DM was an independent predictor of LV remodeling （RR 2.1, 95%CI 1.31-4.79, P=0.02）. The rate of rehospitalization due to heart failure did not differ between diabetic and non-diabetic patients （12.9%vs. 8.1%, P=0.15）, however, more adverse events occurred in patients with LV remodeling comparing to those without LV remodeling （25.8% vs. 6.6%, P 〈 0.001）. Conclusions Diabetic patients with STEMI often have an increased risk of LV remodeling after treated by primary PCI. Thus, comprehensive therapeutic strategy for diabetic patients presented with STEMI is required considering the poor prognosis of these patients with LV remodeling.