目的:评估空腹血糖(FPG)与冠状动脉疾病(CAD)全因死亡率之间的关系。
方法:该研究包括2004年4月1日至2010年10月31日的18,999名患者。主要终点是住院和随访全因死亡率。根据FPG水平的四分位数,患者分为4组:四分位数1,小于5.1mmol/L;四分位数2,5.1至小于5.9mmol/L;四分位数3,5.9至小于7.5mmol/L;四分位数4,7.5mmol/L或更高.血浆葡萄糖单位的转换因子为1.00mmol/L等于18mg/dL。以mg/dL表示,在我们的数据分析中使用的4个四分位数范围的血浆葡萄糖浓度≤90.0mg/dL,90.1-106.0mg/dL,106.1mg/dL-135.0mg/dL且≥135.1mg/dL。四分位数1被认为是低血糖组,四分位数2和3作为血糖正常组,四分位数4为高血糖组。
结果:在急性心肌梗死患者中,血糖异常组的全因死亡率高于血糖正常组:四分位数1、2、3和4的住院死亡率为1.0%,0.9%,0.2%,和1.5%,分别(P=.001);四分位数1、2、3和4的随访死亡率为1.7%,0.9%,0.3%,和1.8%,分别(P<.001)。在稳定型CAD患者中,各组间死亡率无显著差异.然而,不稳定型心绞痛患者,与血糖异常组相比,血糖正常组的随访死亡率较低,院内死亡率大致相等.在调整混杂因素后,这一观察持续存在。
结论:较低的FPG水平与死亡率之间的关联在CAD的不同范围内存在差异。在急性心肌梗死患者中,有一个U型关系。在稳定型冠心病或不稳定型心绞痛患者中,轻度至中度降低的FPG水平与全因死亡率的升高或降低均不相关.
OBJECTIVE: To assess the association between fasting plasma glucose (FPG) and all-cause mortality across the spectrum of coronary artery disease (CAD).
METHODS: The study included 18,999 patients during a study period of April 1, 2004, through October 31, 2010. The primary end points were in-hospital and follow-up all-cause mortality. According to the quartiles of FPG levels, patients were categorized into 4 groups: quartile 1, less than 5.1 mmol/L; quartile 2, 5.1 to less than 5.9 mmol/L; quartile 3, 5.9 to less than 7.5 mmol/L; and quartile 4, 7.5 mmol/L or greater. The conversion factor for units of plasma glucose is 1.00 mmol/L equals 18 mg/dL. Presented as mg/dL, the 4 quartile ranges of plasma glucose concentrations used in our data analysis are ≤90.0 mg/dL, 90.1-106.0 mg/dL, 106.1 mg/dL-135.0 mg/dL and ≥135.1 mg/dL. Quartile 1 was recognized as the lower glycemic group, quartiles 2 and 3 as the normoglycemic groups, and quartile 4 as the higher glycemic group.
RESULTS: In patients with acute myocardial infarction, all-cause mortality for the dysglycemic groups was higher than for the normoglycemic groups: in-hospital mortality for quartiles 1, 2, 3, and 4 was 1.0%, 0.9%, 0.2%, and 1.5%, respectively (P=.001); follow-up mortality for quartiles 1, 2, 3, and 4 was 1.7%, 0.9%, 0.3%, and 1.8%, respectively (P<.001). In patients with stable CAD, no significant differences in mortality were found among groups. However, in patients with unstable angina pectoris, the normoglycemic groups had lower follow-up mortality and roughly equal in-hospital mortality compared with the dysglycemic groups. After adjusting for confounding factors, this observation persisted.
CONCLUSIONS: The association between lower FPG level and mortality differed across the spectrum of CAD. In patients with acute myocardial infarction, there was a U-shaped relationship. In patients with stable CAD or unstable angina pectoris, mildly to moderately decreasing FPG level was associated with neither higher nor lower all-cause mortality.