急性心肌梗死高血糖地控制.ppt

急性心肌梗死高血糖的控制 中山大学附属第一医院内分泌科 肖 海 鹏 欧洲心脏调查结果-分组 GAMI:急性心梗患者中的糖代谢异常 GAMI :新诊断高血糖是心肌梗死后“无心血管事件存活”的预测因素 Diabetics with a non-ST elevation ACS have a worse outcome than nondiabetics In the OASIS registry of 8013 patients with a non-ST elevation acute coronary syndrome (unstable angina or non Q-wave myocardial infarction), 21 percent had diabetes. After a two year follow-up, diabetic patients had a significantly higher combined event rate (cardiovascular death, new myocardial infarction, stroke, new heart failure) than nondiabetics (relative risk 1.56). Data from Malmberg, K, Yusuf, S, Gerstein, HC, et al. Circulation 2000; 102:1014. Diabetes increases coronary mortality with and without a prior MI In a seven year follow up of 1059 subjects with type 2 diabetes and 1378 nondiabetics, diabetics with or without a prior myocardial infarction (MI) had a greater mortality from coronary disease compared to nondiabetics (42 versus 16 percent for those with a prior MI and 15 versus 2 percent for those without a prior MI. The rate of coronary death and fatal and nonfatal MI in diabetics without a prior MI was the same as in nondiabetics with a prior MI, providing part of the rationale for considering type 2 diabetes a coronary equivalent. Data from Haffner, SM, Lehto, S, Ronnemaa, T, et al, N Engl J Med 1998; 339:229. Hyperglycemia and Outcome After Acute MI Predictive Value of Admission Glucose Fasting glucose within 24hrs of admission HbA1c on admission U-shaped curve Intensive insulin therapy reduces mortality in patients with diabetes after myocardial infarction The Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction (DIGAMI) trial randomly assigned 620 diabetic patients to routine care (control group) or intensive therapy with a continuous insulin infusion. After an average followup of 3.4 years, the mortality in the control group was directly related to the admission blood glucose concentration ( 234 mg/dL