【摘要】 目的评价糖化血红蛋白(Hb A1c)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、Hb A1c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Hb A1c值分为3组,组1(Hb A1c≤5.6%,85例)、组2(5.7%≤Hb A1c≤6.4%,117例)、组3(Hb A1c≥6.5%,103例)。结果临床随访平均(1 075±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)。Hb A1c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,Hb A1c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,Hb A1c是1年及以上MACE发生及死亡的独立预测因子。更多还原

【Abstract】 Objective To evaluate the influence of glycosylated hemoglobin on admission( Hb A1c)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. Hb A1 c 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( Hb A1 c ≤5. 6%,n = 85); group 2( 5. 7% ≤ Hb A1 c ≤6. 4%,n = 117); and group 3( Hb A1c≥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 Hb A1c( P = 0. 010) was associated with long-term( more than 1 year) MACE. After multivariate analysis,Hb A1c( HR: 1. 34,95% CI: 1. 099-1. 633,P = 0. 004) was independently associated with long-term( more than 1 year) mortality. Conclusions Hb A1 c is an independent predictor of one-year and long-term outcomes in STEMI patients treated with primary percutaneous coronary intervention.更多还原