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糖尿病和急性冠状动脉综合征后的死亡率
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
概括
糖尿病显著增加了急性冠状动脉综合征 (ACS) 后的死亡风险,包括ST段升高心肌梗塞 (STEMI) 和不稳定的胸痛/非STEMI (UA/NSTEMI). 这强调了糖尿病患者患有心脏病的需要积极管理.
科学领域:
- 心脏病学 心脏病学
- 糖尿病学 糖尿病学
- 公共卫生 公共卫生
背景情况:
- 糖尿病是一种日益严重的全球流行病,导致心血管疾病和死亡率的增加.
- 糖尿病对急性冠状动脉综合征 (ACS) 后死亡率的具体影响需要进一步澄清.
研究的目的:
- 评估糖尿病对患有ACS的患者死亡率的影响.
- 通过使用全面的患者数据库,分析广泛的ACS病例.
主要方法:
- 来自11个随机临床试验 (1997-2006) 的糖尿病患者的综合亚组分析,评估了ACS疗法.
- 包括62,036名患有ACS (STEMI和UA/NSTEMI) 的患者,其中10,613人 (17.1%) 患有糖尿病.
- 多变量模型根据基线特征,ACS表现和处理进行调整,以确定独立的关联.
主要成果:
- 糖尿病与UA/NSTEMI (2.1%对1.1%) 和STEMI (8.5%对5.4%) 患者的30天死亡率显著增加有关.
- 经过调整后的分析证实糖尿病与30天死亡率的增加独立相关 (UA/NSTEMI OR 1.78; STEMI OR 1.40).
- 在ACS后的糖尿病患者中,一年死亡率也明显高 (UA/NSTEMI HR 1.65;STEMI HR 1.22),UA/NSTEMI患者的风险与非糖尿病STEMI患者相似.
结论:
- 糖尿病在ACS后具有显著不利的预后,即使使用现代治疗方法.
- 对于患有不稳定性缺血性心脏病的高风险糖尿病患者,积极的治疗策略至关重要.
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