入院应激性高血糖及糖化血红蛋白对非糖尿病急性心肌梗死患者PCI术后的影响

Effect of Intensive Stress Hyperglycemia and Glycosylated Hemoglobin on Clinical Prognosis in non-diabetic patients with acute myocardial infarction after PCI

目的探讨入院应激性高血糖及糖化血红蛋白水平对非糖尿病急性心肌梗死患者经皮冠状动脉介入(PCI)术后的临床预后影响。方法入选452例行经皮冠状动脉介入(PCI)治疗的非糖尿病急性心肌梗死患者,根据入院血糖(admission glucose,AG)及糖化血红蛋白(glycosylated hemoglobin A1c,HbA1c)水平被分为四组:A组(AG<120mg/dL+HbA1c<5.1%)113例;B组(AG<120mg/dL+HbA1c≥5.1%)114例;C组(AG≥120mg/dL+HbA1c<5.1%)108例;D组(AG≥120mg/dL+HbA1c≥5.1%)117例。主要终点包括全因死亡及非致死性心肌梗死,并对比各组患者基线、临床特征及其他主要心血管不良事件(MACE)的发生情况。结果所有患者的主要终点事件发生率为13.7%。与其他3组相比,D组患者的全因死亡率(15.7%)、非致死性心肌梗死(6.8%)及其他MACE事件发生率(8.6%)均明显增高(P<0.05)。多因素分析入院高血糖合并高HbA1c可作为主要终点事件发生的独立预测因子(HR,2.65;95%CI:1.17-6.58,P=0.02)。结论入院高血糖合并高HbA1c水平可明显增加非糖尿病急性心肌梗死患者经皮冠状动脉介入治疗术后全因死亡、非致死性心肌梗死及其他MACE事件的发生率,可作为临床预后的独立预测因子。

Objective We aimed to investigate how admission hyperglycemia and glycosylated hemoglobin A1c（HbA1c） affects clinical prognosis of nondiabetic patients after primary percutaneous coronary intervention for acute myocardial infarction （AMI）. Methods We retrospectively analyzed 452 consecutive nondiabetic patients with AMI. All patients were treated with pPCI. Patients were divided into four groups according to the median values of admission glucose and HbA1c. Group A： AG〈120mg/dL＋HbA1c〈51%（n=113）; Group B： AG〈120mg/dL＋HbA1c≥51%（n=114）; Group C： AG≥120mg/dL＋HbA1c〈51%（n=108）; Group D： AG≥120mg/dL＋HbA1c≥51%（n=117）. The primary endpoint included a composite of allcause death and nonfatal MI. The four groups were compared with respect to baseline characteristics, clinical characteristics and other major adverse cardiovascular events （MACE）. Results The primary endpoint occurred in 137% of the participants. Compared with other groups, incidence of nonfatal MI（6.8%）, MACE（8.6%） and allcause mortality（15.7%） in the D group were higher than other groups （P〈0.05）. The combination of elevated admission glucose and HbA1c were an independent predictor of the primary endpoint（HR, 2.65;95% CI：1.17-6.58, P=0.02）. Conclusion In patients with AMI undergoing pPCI, the patients with the combination of elevated admission glucose and HbA1c experienced a significantly higher incidence of nonfatal MI, MACE and allcause mortality, as an independent predictor of longterm clinical outcomes.