急性心肌梗死患者入院血糖水平对急性冠状动脉介入术后心肌灌注及近期不良心血管事件的影响

目的:研究入院血糖水平对急性心肌梗死(AMI)患者冠状动脉介入术后心肌灌注及30 d主要不良心血管事件(MACE)的影响。方法:回顾性分析我科2009年1月至2011年12月,298例AMI患者入院血糖水平、临床资料特点和冠状动脉造影结果,记录30d主要不良心血管事件的发生情况。结果:入院血糖≥11.1mmol/L组(C组)患者心脏Killip>1级的比例、白细胞计数、Hs-CRP水平、CK以及CK-MB水平,较血糖为7.8～11.1mmol/L(B组)及血糖<7.8mmol/L(A组)升高(P<0.05),LVEF降低(P<0.05),C组术后1h ST段回落幅度(STR)≥50%、3h T波倒置的比例较A、B组明显减少,C组经皮冠状动脉腔内介入术(PCI)后30 d内,MACE中急性心力衰竭(心衰)、再发非致死性AMI、恶性心律失常及心源性死亡发生率明显较A、B组升高(P<0.05)。结论:随着入院血糖水平的升高,AMI介入术后心肌灌注水平不断降低,30 d MACE发生率不断升高,积极控制血糖可能有利于改善AMI介入术后心肌灌注,降低术后近期MACE的发生。

Influence of admission serum glucose level on myocardial perfusion and short-term major adverse cardiovascular events in patients with acute myocardial infarction after percutaneous coronary intervention

Objective:To study the influence of admission serum glucose(ASG) level on myocardial perfusion and short-term major adverse cardiovascular events(MACE) in patients with acute myocardial infarction(AMI) after percutaneous coronary intervention(PCI).Methods:Retrospectively analyze ASG level,clinical characteristics,coronary angiography results,and record the incidence of 30-day MACE in 298 patients with AMI from January 2009 to December 2011 of our hospital.Results:The proportion of cardiac Killip>1 level,white cell numbers,Hs-CRP concentrations,CK and CK-MB levels were significantly increased in patients of ASG≥11.1mmol/L group(Group C),compared with those in patients in ASG of 7.8~11.1mmol/L(Group B) and ASG <7.8mmol/L(Group A)(P<0.05).There was less frequently complete ST segment resolution and early T wave inversion in group C than those in group B and A after PCI(P<0.05).There were more patients suffering from acute heart failure,recurrent non-fatal myocardial infarction,cardiac malignant arrhythmia and cardiac sudden death of MACE in group C than those in group A and B(P<0.05).Conclusion:As the ASG level increased,myocardial perfusion levels in patients with AMI after PCI were decreased,and the incidence of 30-day MACE was increased.Therefore,strictly controlling ASG seems to be beneficial for improving myocardial perfusion and reducing short-term MACE.