Short-term mortality of myocardial infarction patients with diabetes or hyperglycaemia during admission

被引:66
作者
Sala, J
Masiá, R
de Molina, FJG
Fernández-Real, JM
Gil, M
Bosch, D
Ricart, W
Sentí, M
Marrugat, J
机构
[1] Inst Municipal Invest Med, Unitat Lipids & Epidemiol Cardiovasc, E-08003 Barcelona, Spain
[2] Hosp Girona Josep Trueta, Serv Cardiol, Girona, Spain
[3] Hosp Girona Josep Trueta, Unitat Coronaria, Girona, Spain
[4] Hosp Girona Josep Trueta, Serv Endocrinol, Girona, Spain
关键词
D O I
10.1136/jech.56.9.707
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Aim: The hypothesis that patients with hyperglycaemia during admission, regardless of previous diagnosis of diabetes, have worse prognosis than those with normal glucose values is controversial. The objective was to assess the role of hyperglycaemia on short-term mortality after myocardial infarction (MI). Methods and Results: A cohort study nested in a prospective registry of MI patients in the reference hospital of Gerona, Spain was performed. All consecutive MI patients under 75 were registered between 1993 and 1996. Patient and clinical characteristics, including previous diagnosis of diabetes, glycaemia on admission and in the next four days, were recorded. Patients with glycaemia on admission or four day mean glycaemia >6.67 mmol/l were considered hyperglycaemic. The main outcome measure was mortality at 28 days. Of 662 patients with MI included, 195 (29.7%) had previously known diabetes mellitus, but 457 (69.0%) had glycaemia >6.67 mmol/l on admission. Patients with hyperglycaemia on admission were older, more often female, more frequently had a previous diagnosis of diabetes, developed more complications, and had higher 28 day mortality. The effect of admission glycaemia >6.67 mmol/l on 28 day mortality was independent of major confounding factors, particularly previous diagnosis of diabetes (OR=4.20, 95% confidence intervals 1.18 to 14.96). Conclusions: Higher 28 day mortality was observed among MI patients with glycaemia on admission >6.67 mmol/l compared with patients with lower levels, independently of major confounding variables and, particularly, previous diagnosis of diabetes. This early, simple, and inexpensive marker of bad prognosis after MI should prompt the application of more aggressive treatment of MI and risk factors and, probably, of glycaemia during admission.
引用
收藏
页码:707 / 712
页数:6
相关论文
共 39 条
  • [1] EFFECT OF DIABETES-MELLITUS ON SHORT-TERM AND LONG-TERM MORTALITY-RATES OF PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION - A STATEWIDE STUDY
    ABBUD, ZA
    SHINDLER, DM
    WILSON, AC
    KOSTIS, JB
    [J]. AMERICAN HEART JOURNAL, 1995, 130 (01) : 51 - 58
  • [2] [Anonymous], 1990, CIRCULATION, V82, P664
  • [3] Mechanisms determining course and outcome of diabetic patients who have had acute myocardial infarction
    Aronson, D
    Rayfield, EJ
    Chesebro, JH
    [J]. ANNALS OF INTERNAL MEDICINE, 1997, 126 (04) : 296 - 306
  • [4] BAUMGARTNERPARZER SM, 1995, DIABETOLOGIA, V38, P1367
  • [5] HYPERGLYCEMIA AND PROGNOSIS OF ACUTE MYOCARDIAL-INFARCTION IN PATIENTS WITHOUT DIABETES-MELLITUS
    BELLODI, G
    MANICARDI, V
    MALAVASI, V
    VENERI, L
    BERNINI, G
    BOSSINI, P
    DISTEFANO, S
    MAGNANINI, G
    MURATORI, L
    ROSSI, G
    ZUARINI, A
    [J]. AMERICAN JOURNAL OF CARDIOLOGY, 1989, 64 (14) : 885 - 888
  • [6] Fasting blood glucose: An underestimated risk factor for cardiovascular death - Results from a 22-year follow-up of healthy nondiabetic men
    Bjornholt, JV
    Erikssen, G
    Aaser, E
    Sandvik, L
    Nitter-Hauge, S
    Jervell, J
    Erikssen, J
    Thaulow, E
    [J]. DIABETES CARE, 1999, 22 (01) : 45 - 49
  • [7] Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview
    Capes, SE
    Hunt, D
    Malmberg, K
    Gerstein, HC
    [J]. LANCET, 2000, 355 (9206) : 773 - 778
  • [8] Ceriello A, 1997, DIABETIC MED, V14, pS45, DOI 10.1002/(SICI)1096-9136(199708)14:3+<S45::AID-DIA444>3.3.CO
  • [9] 2-I
  • [10] The relationship between glucose and incident cardiovascular events
    Coutinho, M
    Gerstein, HC
    Wang, Y
    Yusuf, S
    [J]. DIABETES CARE, 1999, 22 (02) : 233 - 240