入院糖化血红蛋白对接受直接经皮冠状动脉介入治疗的急性心肌梗死患者长期预后的影响

摘要

Objective To evaluate the influence of glycosylated hemoglobin on admission ( HbA1c) on long-term outcomes of patients with acute myocardial infarction treated with primary percutaneous coronary intervention. Methods A total of 305 patients with acute ST-segment elevation myocardial infarction ( STEMI) received primary percutaneous coronary intervention from Dec 2007 to Dec 2012 were enrolled in this study. HbA1c was measured on admission for all patients. Clinic characteristics、biochemical indicator, death and major adverse cardiac events ( MACE) during follow up were recorded. Patients were classified into three groups: group 1(HbA1c≤5. 6%,n=85); group 2 (5. 7%≤HbA1c≤6. 4%,n=117); and group 3 (HbA1c≥6. 5%,n=103). Results The patients were followed up for a mean of (1 075 ± 414) days. 23 patients ( 7. 5%) died and MACE occurred in 37 patients ( 12%) . MACE rate in one year was higher in group 3 ( 8. 7%) than in group 2 ( 2. 6%) and group 1 ( 1. 2%; both p < 0. 05 ) . One-year mortality rate was higher in group 3 ( 5. 8%) than in group 2 ( 0. 9%) and group 1 ( 0 ) %, both p <0. 05). Elevated HbA1c (p =0. 010) was associated with long-term (more than 1 year) MACE. After multivariate analysis, HbA1c (HR:1. 34, 95%CI:1. 099-1. 633, p=0. 004) was independently associated with long-term (more than 1 year) mortality. Conclusions HbA1c is an independent predictor of one-year and long-term outcomes in STEMI patients treated with primary percutaneous coronary intervention.%目的：评价糖化血红蛋白( HbA1c）对接受直接经皮冠状动脉介入治疗( PCI）的急性ST段抬高型心肌梗死( STEMI）患者长期预后的影响。方法入选2007年12月1日至2012年12月31日接受直接PCI的STEMI患者305例,记录患者的临床特点、HbA1c等生化指标、随访期间死亡和主要不良心血管事件( MACE）发生情况,根据患者的 HbA1c 值分为3组,组1( HbA1c≤5.6%,85例）、组2(5.7%≤HbA1c≤6.4%,117例）、组3(HbA1c≥6.5%,103例）。结果临床随访平均(1075±414） d,随访中死亡23例(7.5%）,发生MACE 37例(12%）。1年内MACE 发生率比较,组3(8.7%,9/103）明显高于组2(2.6%,3/117）和组1(1.2%,1/85；p=0.018）；1年内死亡率比较,组3(5.8%,6/103）明显高于组2(0.9%,1/117）和组1(0%,0/85；p=0.010）。 HbA1c和长期(1年以上）MACE发生相关(p=0.015）；多因素Cox回归分析,校正其他因素后,HbA1c是长期(1年以上）死亡率的独立预测因子(HR：1.340,95%CI：1.099~1.633,p=0.004）。结论在接受直接PCI的STEMI患者,HbA1c是1年及以上MACE发生及死亡的独立预测因子。