糖尿病对急性ST段抬高型心肌梗死直接PCI后住院及远期病死率的影响

目的 探讨糖尿病对急性ST段抬高型心肌梗死直接PCI术后住院及远期病死率的影响.方法 将248例连续行直接PCI的ST段抬高型急性心肌梗死患者分为糖尿病组（82例）和非糖尿病组（166例）.分析两组患者的一般临床情况、冠状动脉病变特点、住院及远期[平均（42.33±17.13）个月]病死率.结果 糖尿病合并ST段抬高型心肌梗死患者的比例为33％.糖尿病组患者入院血糖、糖化血红蛋白及血肌酐水平均高于非糖尿病组（P＜0.01,P＜0.01,P＜0.05）.糖尿病组心功能不全（killipⅡ～Ⅳ级）的患者多于非糖尿病组（P＜0.05）.双支病变及三支病变的患者两组差异无统计学意义,但糖尿病组单支病变的患者明显少于非糖尿病组（P＜0.05）.糖尿病组患者住院病死率与非糖尿病组相比差异无统计学意义,但远期病死率糖尿病组患者明显高于非糖尿病组（P＜0.05）.COX回归分析显示,糖尿病（HR=3.65,95％CI 1.11～11.96）和心功能不全（HR=3.85,95％CI l.41～10.46）是远期病死率的独立预测因素.结论 糖尿病合并ST段抬高型心肌梗死患者PCI术后住院病死率与非糖尿病组相比差异无统计学意义,但糖尿病和心功能不全是ST段抬高型心肌梗死PCI术后远期病死率升高的独立影响因素.

Impact of diabetes on in-hospital and late mortality in patients with acute myocardial infarction who undergone percutaneous coronary intervention

Objective To evaluate the impact of diabetes mellitus（DM） on in-hospital and late mortality in patients who suffered acute ST-elevation myocardial infarction （STEMI） and underwent successful percutaneous coronary intervention （PCI）.Methods A total of 248 patients with AMI consecutively undergoing successful PCI were divided into diabetic group（DM,n=82） and non-diabetic group（NDM,n=166）.The characteristics,coronary angiogram and mortality of in-hospital and mean （42.33±17.13）months were analyzed.Results In the study population（n=248）,33％ of STEMI had diabetes.The DM group had a higher level of admission mean blood glucose,hemoglobin Alc and serum creatinine than in NDM group （P＜0.01,P＜0.01,P＜0.05）.The patients of Killip Ⅱ-Ⅳ class were more in DM group than in NDM group（P＜0.05）.No significant differences were observed in the patients of three and double-vessel coronary disease between the two groups,but the patients of single-vessel coronary disease were less in DM group than in NDM group （P＜0.05）.No significant differences of in-hospital mortality between the groups,but the late mortality were significantly higher in STEMI group with DM.A multivariate Cox regression analysis showed that DM（HR=3.65,95％CI 1.11-11.96） and cardiac function（Killip class） （HR=3.85,95％CI 1.41-10.46） were independent predictors of the late mortality.Conclusion The in-hospital mortality was no difference between the patients of STEMI with DM and without DM.The late mortality were significantly higher in STEMI group with DM.DM and cardiac function （Killip class） were independent predictors of the late mortality.