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糖尿病と急性冠動脈症候群後の死亡率
Sean M Donahoe1, Garrick C Stewart, Carolyn H McCabe
1Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, New York, USA.
JAMA
|August 21, 2007
まとめ
糖尿病は,STセグメント上昇心筋梗塞 (STEMI) と不安定なアンギナ/非STEMI (UA/NSTEMI) を含む急性冠動脈症候群 (ACS) の後の死亡リスクを大幅に増加させます. これは,心臓病の糖尿病患者の積極的な管理の必要性を強調しています.
科学分野:
- 心臓病学 心臓病学
- 糖尿病学 糖尿病学
- 公衆衛生は公衆衛生である.
背景:
- 糖尿病は,増加する世界的な流行病であり,心血管疾患と死亡率の増加に寄与しています.
- 急性冠動脈症候群 (ACS) の後の死亡率に対する糖尿病の特定の影響については,さらなる明確化が必要である.
研究 の 目的:
- ACS.を患っている患者の死亡率に対する糖尿病の影響を評価する.
- 総合的な患者データベースを使用して,ACS症例の幅広いスペクトルを分析します.
主な方法:
- ACS治療法を評価した11件のランダム化臨床試験 (1997年−2006年) の糖尿病患者のグループ分析.
- ACS (STEMIとUA/NSTEMI) 患者62,036人,糖尿病患者10,613人 (17.1%) を含む.
- ベースラインの特性,ACSの表示,および独立した関連性を決定するための処理に調整された多変量モデル.
主要な成果:
- 糖尿病は,UA/NSTEMI (2.1%対1.1%) とSTEMI (8.5%対5.4%) の両方の患者で,30日間の死亡率が著しく高かった.
- 調整した分析により,糖尿病は独立して30日間の死亡率の増加と関連していることが確認された (UA/NSTEMI OR 1.78; STEMI OR 1.40).
- 1年後の死亡率は,ACS後の糖尿病患者でも著しく高かった (UA/NSTEMI HR 1.65; STEMI HR 1.22),UA/NSTEMI患者は糖尿病でないSTEMI患者と同様のリスクを示した.
結論:
- 糖尿病は,現代的な治療法であっても,ACSの後に著しく悪質な予後を与える.
- 積極的な管理戦略は,不安定な心不全性疾患を有する高リスクの糖尿病患者にとって非常に重要です.
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