入院血糖水平与急诊冠状动脉介入治疗术后患者预后的相关性

目的探讨急性心肌梗死（AMI）患者血糖水平与经皮冠状动脉介入（PCI）干预后住院期间心脏不良事件的相关性。方法入选312例初发AMI患者于入院即刻测定静脉血糖,并于发病24h内行急诊PCI。根据入院即刻血糖水平分为高血糖组（血糖〉11mmol／L,44例）和血糖正常组（血糖≤11mmol／L,268例）;按是否合并糖尿病分为糖尿病组（81例）和非糖尿病组（231例）。随访患者住院期间病死率及术后180d心脏不良事件发生率。结果无论是否合并糖尿病,高血糖组住院期间病死率及PCI术后180d心脏不良事件发生率均明显高于血糖正常组（18．2％比3．0％,P〈0．001;25％比12．7％,P=0．047）,多因素分析显示入院即刻血糖为死亡及心脏不良事件的独立预测因素（OR5．15,95％CI 1．74～15．28,P=0．003及OR 2．84,95％CI 1．18～6．83,P=0．019）,而是否合并糖尿病对上述终点无明显影响。结论无论是否合并糖尿病,入院即刻高血糖是AMI患者PCI术后住院期间病死率和180d心脏不良事件的相对独立危险因素。

The prognostic value of admission blood glucose level in acute myocardial infarction after primary percutaneous coronary intervention

OBJECTIVE: To evaluate the predictive value of the admission blood glucose level for in-hospital mortality and major adverse cardiac events (MACE) rate in patients with acute myocardial infarction (AMI) who underwent primary percutaneous coronary intervention (PCI). METHODS: The cohort study comprised 312 consecutive patients with AMI who underwent primary PCI within 24 hours after the onset of chest pain, including diabetic patients and non-diabetic patients. According to the levels of the admission glucose (11 mmol/L), these patients were divided into two groups: a high admission glucose group and a normal admission glucose group. RESULTS: There were no significant differences in age, hypertension, hyperlipidemia, LVEF, CK-MB and hypersensitive C reactive protein. PCI success rate was similar in both groups (P > 0.05). The in-hospital mortality and 180-day MACE rate were significantly higher in patients with high concentration of admission glucose than in patients with normal concentration (18.2% vs 3.0% P < 0.001, 25% vs 12.7%, P = 0.047). However, there was no significant difference in mortality and 180-day MACE rate between diabetic and non-diabetic patients. Binary logistic regression analysis indicated that high concentration of the admission glucose remained an independent predicator of the in-hospital mortality (OR 5.15, 95% CI 1.74 - 15.28, P = 0.003) and higher occurrence rate of 180-day MACE (OR 2.84, 95% CI 1.18 - 6.83, P = 0.019). CONCLUSIONS: High concentration of admission glucose, but not the diagnosis of diabetes, was an important predictor for in-hospital mortality and 180-day MACE rate in patients with AMI who underwent primary PCI.