入院糖化血红蛋白水平对行经皮冠状动脉介入治疗的无糖尿病病史患者远期预后的影响

目的:探讨入院糖化血红蛋白(HbA1C)水平对行经皮冠状动脉介入治疗(PCI)的无糖尿病病史患者临床远期预后的影响。方法:纳入2013年1月至12月在我院行PCI的无糖尿病病史的冠心病患者6944例。根据入院HbA1C水平分为三组:HbA1C<5.7%组、HbA1C 5.7%~6.4%组和HbA1C≥6.5%组。2年随访的主要终点为主要不良心血管事件(MACE),包括死亡、再次心肌梗死和血运重建。分析入院HbA1C水平对行PCI的无糖尿病病史患者临床远期预后的影响。结果:在6944例行PCI的无糖尿病病史患者中,HbA1C<5.7%组1302例(18.75%),HbA1C 5.7%~6.4%组4344例(62.56%),HbA1C≥6.5%组1298例(18.69%)。2年随访结果显示,HbA1C≥6.5%组和HbA1C 5.7%~6.4%组的MACE发生率显著高于HbA1C<5.7%组(11.0%vs 10.5%vs 8.4%,P=0.047)。多因素分析显示:HbA1C 5.7%~6.4%组和HbA1C≥6.5%组发生MACE风险分别是HbA1C<5.7%组的1.262倍(95%CI:1.022~1.559,P=0.031)和1.304倍(95%CI:1.010~1.682,P=0.041)。结论:在接受PCI的无糖尿病病史的冠心病患者中,入院HbA1C水平是2年MACE发生的独立预测因子。

Impact of Glycosylated Hemoglobin Levels at Admission on Long-term Prognosis After Percutaneous Coronary Intervention in Patients Without Diabetes History

Objective:To investigate the impact of glycosylated hemoglobin(HbA1C)levels at admission on long-term prognosis after percutaneous coronary intervention(PCI)in patients without diabetes mellitus(DM)history.Methods:A total of 6944 patients with coronary heart disease and without DM history,who underwent PCI from January to December 2013 in our hospital,were enrolled.According to the admission HbA1C levels,patients were divided into three groups:HbA1C<5.7%group,HbA1C 5.7%-6.4%group and HbA1C≥6.5%group.Patients were followed up at 1,6,12 and 24 months post discharge.The primary endpoint was major adverse cardiovascular events(MACE),defined as a composite of death,reinfarction or revascularization.Results:Of the 6944 patients,1302(18.75%)were in HbA1C<5.7%group,4344(62.56%)in the HbA1C 5.7%-6.4%group,and 1298(18.69%)in the HbA1C≥6.5%group.The 2-year follow-up results showed that the incidence of MACE was significantly higher in the HbA1C≥6.5%group and the HbA1C 5.7%-6.4%group than in the HbA1C<5.7%group(11.0%vs 10.5%vs.8.4%,P=0.047).Multivariate analysis showed that the risk of MACE in the HbA1C 5.7%-6.4%group and HbA1C≥6.5%group was 1.262 times and 1.304 times higher than that in the HbA1C<5.7%group(95%CI:1.022-1.559,P=0.031;95%CI:1.010-1.682,P=0.041,respectively).Conclusions:HbA1C level at admission is an independent predictor of 2-year MACE post PCI in patients without history of DM.