糖化血红蛋白水平对行PCI的非ST段抬高型心肌梗死患者远期预后的影响

Influence of glycated hemoglobin on long-term prognosis in patients with non-ST-segment elevation myocardial infarction undergone PCI

目的探讨糖化血红蛋白水平与行经皮冠状动脉介入治疗(PCI)的非ST段抬高型心肌梗死(NSTEMI)患者远期预后的关系。方法连续入选2009年1月至2012年10月于西安交通大学第一附属医院、西安市中心医院及陕西省人民医院确诊为NSTEMI并行PCI的890例患者。根据是否患有糖尿病及糖化血红蛋白(HbA1c)水平分成4组:无糖尿病且HbA1c水平<5.7%(n=417);无糖尿病且HbA1c水平在5.7%~6.5%(n=237);有糖尿病且HbA1c水平<7.0%(n=138);有糖尿病且HbA1c水平≥7.0%(n=98)。分析不同分组患者3年不良心血管事件、全因性死亡、心血管原因死亡、再发非致死性心肌梗死、心力衰竭(心衰)再次住院、再次血运重建及脑卒中发生率。结果非糖尿病且5.7%≤HbA1c<6.5%组患者与非糖尿病且HbA1c<5.7%组患者相比较,有较高的3年主要不良心血管事件发生率及死亡率,且有显著性差异(P均<0.05),而糖尿病且HbA1c≥7.0%组与糖尿病且HbA1c<7.0%组相比较,3年主要不良心血管事件发生率及死亡率均无显著差异。且无论是否患有糖尿病,入院血糖水平均是NSTEMI行PCI患者远期不良预后的危险因素。结论在行PCI的NSTEMI合并糖尿病的患者中,HbA1c升高不是其3年主要不良心血管事件及死亡率的危险因素。在NSTEMI行PCI的非糖尿病患者中,HbA1c升高是其3年主要不良心血管事件及死亡率的危险因素。

Objective To discuss the relationship between level of glycated hemoglobin(HbAlc)and longterm prognosis in patients with non-ST-segment elevation myocardial infarction(NSTEMI)undergone PCI.Methods NSTEMI patients undergone PCI(n=890)were chosen from the First Affiliated Hospital of Xi’an Jiaotong University,Center Hospital of Xi’an City and People’s Hospital of Shaanxi Province from Jan.2009 to Oct.2012.All patients were divided,according to incidence of diabetes and HbA1c level,into 4 groups:group 1(without diabetes and Hb A1 c<5.7%,n=417),group 2(without diabetes and HbA1c from 5.7%to 6.5%,n=237),group 3(with diabetes and HbA1c<7.0%,n=138),and group 4(with diabetes and HbA1c≥7.0%,n=98).The incidence rates of major adverse cardiovascular events(MACE),all-cause mortality,death from cardiovascular causes,recurrent nonfatal myocardial infarction,re-hospitalization due to heart failure,re-revascularization and stroke were analyzed in all groups within 3 y after discharged from hospital.Results The incidence of MACE and mortality within 3 y were higher in group 2 than those in group 1(all P<0.05).The incidence of MACE and mortality within 3 y had no significant difference between group 4 and group 3.The level of blood glucose was a risk factor of poor long-term prognosis in NSTEMI patients under gone PCI with or without diabetes.Conclusion The increase of HbA1c level is not the risk factors of MACE and mortality within 3 y in patients with NSTEMI complicated by diabetes undergone PCI,while it is the risk factors of MACE and mortality within 3 y in patients with NSTEMI without diabetes undergone PCI.