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ȣ - 520080 229 |
| Differences Between Diabetic Hypertensive and Non-diabetic Hypertensive Patients With Acute Myocardial Infarction
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| 대한심장학회 Korea Acute Myocardial Infarction Registry 연구자 |
| 이민구, 정명호, 안영근, 채성철, 허승호, 성인환, 김종현, 홍택종, 구본권, 채제건, 채동훈, 윤정한, 배장호, 나승운, 류제영, 김두일, 김기식, 김병옥, 오석규, 채인호, 이명용, 정경태, 조명찬, 김종진, 김영조, 외 Korea Acute Myocardial Infarction Registry Investigators |
BACKGROUND: It is said that patients with Diabetes Mellitus (DM) would have a poorer prognosis after acute myocardial infarction (MI), but the effect of DM on the outcomes of hypertensive patients with acute MI is not still elucidated. OBJECTIVES: The aim of this study was to investigate the effects of DM on long term clinical outcome in acute MI patients with hypertension. METHODS: Employing data from the Korea Acute Myocardial Infarction Registry (KAMIR; November 2005 to December 2006), a total of 2,233 hypertensive patients suffered from acute MI were grouped based on existence of DM : group I: Diabetic hypertension (N=892, 544 men, 66.2±10.9 years of age); group II: Non-diabetic hypertension (N=1341, 938 men, 63.9±12.8 years of age). Primary study outcomes include in-hospital death, major adverse cardiac events (MACE: cardiac death, MI, repeat percutaneous coronary intervention and coronary artery bypass surgery). RESULTS: Hypertensive patients with DM were older and more likely to be women. Group I showed lower left ventricular ejection fraction (p<0.01), more severe heart failure (Killip class ≥ III, p<0.01), longer duration of coronary care unit (CCU) admission (p<0.01) and higher incidence of dyslipidemia (p=0.001). N terminal-pro BNP levels (group 1=4602.5±8710.6 pg/mL vs group 2=2320.8±5837.9 mg/dL, p<0.01) and serum creatinine levels (group 1=1.5±2.6 mg/dL vs group 2=1.1±1.2 mg/dL, p<0.01) were higher in group I. Angiographic findings revealed higher involvement of left main stem (p=0.002) and three vessels (p<0.01) in group I. during follow-up, the rate of cardiac death at 1 month (p=0.001), 6 months (p<0.01), 12 months (p<0.01) were higher in group I than in group II. Also, the rates of composite MACE at 12 months were significantly higher in diabetic hypertension group (p<0.01). CONCLUSIONS: In patients with AMI, diabetic hypertension was associated with worse clinical and angiographic features, with a higher risk of development of severe heart failure and increased risk of death on long term clinical follow up than non-diabetic hypertension.
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