糖化血红蛋白对老年急性心肌梗死患者接受直接经皮冠脉介入治疗远期预后的影响

Influence of glycosylated hemoglobin on long-term prognosis of elderly patients with acute myocardial infarction treated with percutaneous coronary intervention

目的：评价糖化血红蛋白（glycosylated hemoglobin,Hb A1c）对老年急性心肌梗死患者接受直接经皮冠脉介入治疗远期预后的影响。方法：入选2008年6月31日~2012年12月31日在我院接受直接经皮冠脉介入治疗,年龄60岁以上,入院后24小时内测定Hb A1c并且出院后随访〉1年的急性心肌梗死患者233例,根据Hb A1c水平分为3组,组I（Hb A1c≤5.6%,46例）、组II（5.7%≤Hb A1c≤6.4%,92例）、组III（Hb A1c≥6.5%,95例）。分析三组患者1年内主要不良心脏事件（main adverse card iac events,M ACE）和全因死亡率,了解患者入院后Hb A1c水平与急性心肌梗死1年以上长期预后的关系。结果：临床随访平均（977±438）d,随访1年死亡12例（5.2%）,发生不良心脏事件18例（7.7%）。将入选患者分为否认糖尿病组和糖尿病组,否认糖尿病组患者1年内MACE发生率与死亡率三组均一致,组III（12.5%）明显高于组Ⅱ（2.6%）和组I（0%;P=0.026）,但组I与组II之间无明显差异;糖尿病组患者将组Ⅰ与组Ⅱ合并后与组Ⅲ比较在1年内的MACE发生率（P=0.059）及死亡率（P=0.328）上无统计学差异。多因素Cox回归分析,校正其他因素后,Hb A1c是患者长期（1年以上）死亡率的独立预测因子（HR：1.258;95%CI：1.114~1.421;P〈0.001）。结论：在接受直接经皮冠状动脉介入治疗的老年急性心肌梗死患者,Hb A1c是长期死亡发生的独立预测因子。对于既往无糖尿病病史患者,Hb A1c≥6.5%与其1年内发生死亡和主要心脏不良事件显著相关。。

Objective： To evaluate the influence of glycosylated hemoglobin （HbAlc） on long-term prognosis of elderly patients with acute myocardial infarction treated with primary percutaneous coronary intervention （PCI）.Methods： A total of 233 acute myocardial infarction patients with age ≥60 years old who received primary PCI during June 2008 to December 2012 and followed up 〉1 year after charge were included in this study. Blood sample for HbAlc were obtained on the first 24 h after admission. Patients were classified into three groups： group I （HbAlc _〈5.6%; n=46）; group Ⅱ （5.7%≤ HbAlc ≤6.4%; n=92）; and group III （HbAlc ≥6.5%; n=95）. Results： The patients were followed up for a mean period of （977±438） days. Totally 12 patients （5.2%） died and MACE occurred in 18 patients （7.7%）.The patients were divided into diabetes group and diabetes-denied group. MACE and mortality in one year which were equal in diabetes-denied was higher in groupⅢ（12.5%） compared with group Ⅱ （2.6%） and group Ⅰ （0%; P=0.026）, but there were not different between group Ⅱ and group Ⅰ. In diabetes group, group I and group II were merged to compare with groupⅢ, the differences of MACE and mortality in one year were not found between them in the result. After multivariate analysis, HbAlc （hazard ratio, 1.258; 95% CI： 1.114-1.421; P〈0.001） was independently associated with long-term （more than 1 year） mortality. Conclusion： The HbAlc is an independent predictor of long-term outcomes in elderly patients with acute myocardial infarction treated with primary PCI. HbAlc ≥6.5 were associated with MACE and mortality in 1 year for the diabetes-denied patients.