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ȣ - 520186 163 |
Hyperglycemic Patients without Diabetes Mellitus Have Worse Outcomes than Normoglycemic Patients after Non-ST Segment Elevation Myocardial Infarction |
대한심장학회 Korea Acute Myocardial Infarction Registry 연구자 |
조재영, 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 reported that hyperglycemia is encountered in up to 50% of all ST segment elevation myocardial infarction (STEMI) patients, whereas previously diagnosed DM is present in only 20% to 25% of STEMI patients. Blood glucose level at admission has been reported as a major independent predictor of both in-hospital and long-term outcome regardless of diabetic status in STEMI. The aim of this study was to evaluate whether initial glucose level affects the clinical outcomes in non-diabetic patients with non-STEMI (NSTEMI). Subjects and Methods : We have studied 3740 consecutive non-diabetic patients with NSTEMI, who were registered in Korea Acute Myocardial Infarction Registry (KAMIR) between Oct 2005 to Jun 2007 (64.0±14.1 years, 2534 males). The patients were divided into three groups according to initial blood glucose levels(Group I: glucose <140 mg/dL, Group II: 140 mg/dL≤ glucose <200 mg/dL, Group III: glucose ≥200 mg/dL). Cardiac deaths, target-lesion revascularizations (TLR) and composite major adverse cardiac events (MACE) were compared among three groups. Results: In-hospital death increased along with blood glucose level (Group I vs. Group II vs. Group III: 1.4% vs. 5.4% vs. 7.5%, p<0.001) with Chi-square analysis. In Kaplan-Meier survival analysis, Group I showed less MACE rate compared with group III (p=0.006 by Log-Rank test). Cardiac death rate of all three groups were significantly different each other. Group I was better than Group II or Group III (6.3% vs. 16.8% or 25.0%, p<0.001 by Log-Rank test) and Group II was better than Group III (16.8% vs. 25.0%, p=0.049 by Log-Rank test). In analysis of TLR, there were no significant differences between blood glucose groups. With logistic regression, age (p=0.007, OR 1.128, 95% CI 1.033-1.231), blood glucose level(p=0.023, OR 1.014, 95% CI 1.002-1.026) and serum total cholesterol level(p=0.035, OR 1.035, 95% CI 1.002-1.069) were independent predictors of cardiac death in non-diabetic patients with NSTEMI. Conclusion : Lowering blood glucose level may improve adverse outcomes even in non-diabetic patients with NSTEMI as well as patients with STEMI.
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