糖尿病病程对急性ST段抬高型心肌梗死患者行经皮冠状动脉介入治疗后冠状动脉微血管阻塞及近期预后的影响

Impact of the duration of diabetes mellitus on coronary microvascular obstruction and short-term outcome after percutaneous coronary intervention in patients with acute ST elevation myocardial infarction

目的 比较急性ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入治疗(PCI)后新诊断糖尿病组与无糖尿病组和既往已知糖尿病组患者冠状动脉微血管阻塞(MVO)及近期预后的差异。方法选取2019年至2021年于首都医科大学附属北京潞河医院行急诊冠状动脉造影并接受PCI的STEMI患者214例,根据糖化血红蛋白(HbA1c)及糖尿病病史将患者分为三组:既往已知糖尿病组(45例),新诊断糖尿病组(43例),无糖尿病组(126例)。比较三组临床基线资料、PCI术后1周及术后3个月左心室舒张末期内径(LVDD)、左心室射血分数(LVEF)的变化,比较三组住院期间主要不良心脑血管事件(MACCE)发生率及MVO发生率。多因素logistic回归分析MVO及MACCE的预测因素。结果 与无糖尿病患者相比,新诊断糖尿病患者体重指数(BMI)、术后TIMI≤2级比例、CKMB峰值、空腹血糖、甘油三酯、糖化血红蛋白明显升高,差异有统计学意义(P<0.05)。三组患者PCI术后1周LVDD和LVEF比较,差异无统计学意义(P>0.05)。新诊断糖尿病患者PCI术后3个月LVDD[(53.6±4.7)mm比(50.9±4.6)mm],LVDD增加值[(3.5±5.7)mm比(0.8±4.5)mm]显著高于无糖尿病患者,差异有统计学意义(P<0.05)。而LVEF[(48.7±4.2)%比(57.4±4.8)%],LVEF增加值[(-0.9±6.7)%比(4.3±5.4)%],新诊断糖尿病患者明显低于无糖尿病患者,差异有统计学意义(P<0.05)。无糖尿病组、新诊断糖尿病组、既往已知糖尿病组三组住院MACCE发生率分别为9.5%、20.9%、26.7%,MVO发生率分别为34.1%、62.8%、37.8%。与无糖尿病组相比,新诊断糖尿病组住院MACCE及MVO发生率明显升高,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,新诊断糖尿病是STEMI患者PCI术后住院MACCE及MVO的独立预测因素。结论 新诊断糖尿病患者比较容易发生微血管阻塞且PCI术后3个月心功能恢复不良,PCI术后近期预后不良。新诊断糖尿病是STEMI患者PCI术后住院MACCE及MVO的独立预测因素。

Objective To compare the coronary microvascular obstruction(MVO)and recent prognosis between the newly diagnosed diabetic mellitus patients and without diabetic mellitus patients and previously known diabetic mellitus patients after percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A Total of 214 patients with STEMI who underwent primary PCI in Beijing Luhe Hospital,Capital Medical University from 2019 to 2021 were included.The patients were divided into three groups according to glycosylated hemoglobin(HbA1c)and history of diabetes:the previously known diabetes mellitus group(n=45),newly diagnosed diabetes group(n=43)and without diabetes mellitus group(n=126).Clinical baseline data,changes in left ventricular diastolic end diameter(LVDD),left ventricular ejection fraction(LVEF)at 1 week after PCI and 3 months after PCI were compared among the three groups.The incidences of major adverse cardiovascular and cerebrovascular events(MACCE)and microvascular obstruction during hospitalization among the three groups were compared.Results The body mass index(BMI),proportion of TIMI≤grade 2,peak CKMB,fasting glucose,triglycerides and HbA1c were significantly higher in the patients with newly diagnosed diabetes compared with those without diabetes(P<0.05).LVDD and LVEF were compared among the three groups at 1 week after PCI,but there was no significant difference(P>0.05).LVDD[(53.6±4.7)mm vs.(50.9±4.6)mm]and the increased value of LVDD[(3.5+5.7)mm vs.(0.8+4.5)mm]between the patients with newly diagnosed diabetes mellitus and those without diabetes mellitus at 3 months after PCI were significantly different(P<0.05).Whereas LVEF[(48.7±4.2)%vs.(57.4±4.8)%]and the increased LVEF[(-0.9±6.7)%vs.(4.3±5.4)%,P<0.05]were significantly lower in the patients with newly diagnosed diabetes than in those without diabetes.The incidences of in-hospital MACCE in the three groups(without diabetes,newly diagnosed diabetes,and previous diabetes)were 9.5%,20.9%,26.7%,respectively;and the incidences of MVO were 34.1%,62.8%,37.8%,respectively.The incidences of in-hospital MACCE and MVO were significantly higher in the patients with newly diagnosed diabetes than in those without diabetes(P<0.005).Multiple logistic regression analysis showed that newly diagnosed diabetes was an independent predictor for in hospital MACCE and MVO after PCI in STEMI patients.Conclusions Patients with newly diagnosed diabetes are relatively prone to microvascular obstruction and have poor recovery of cardiac function 3 months after PC,and the short-term prognosis is poor.