{"title":"急性冠状动脉综合征患者新诊断与既往诊断或无糖尿病：一项系统回顾和荟萃分析","authors":"Donatos Tsamoulis, Michail Papapanou, Dimitrios Platis, Timoleon Giannakas, Nikolaos Ktenopoulos, Loukianos S Rallidis","doi":"10.1080/14779072.2025.2522225","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Νewly diagnosed diabetes mellitus (NDDM) among acute coronary syndrome (ACS) patients represents a distinct clinical entity, although available data remain inconclusive. This systematic review and meta-analysis compared ACS patients with NDDM to those without diabetes mellitus (DM) and those with previously diagnosed DM (PDDM).</p><p><strong>Methods: </strong>We searched PubMed, Scopus, and CENTRAL until 10 December 2024. We assessed myocardial necrosis, prognosis, coronary artery disease (CAD) extent, left ventricular ejection fraction (LVEF) at discharge, and cardiometabolic profiles. ROBINS-E and GRADE assessed bias risk and evidence certainty, respectively.</p><p><strong>Results: </strong>Out of 257,859 ACS patients from 34 studies, 5.2% had NDDM. NDDM patients had higher mean peak hs-cardiac troponin I levels compared to PDDM patients (MD 18,389.15 [95% CI 2975.96, 33802.34]) and intermediate post-discharge prognosis between PDDM and non-DM patients [5-MACE; RR 0.80 (95% CI 0.71, 0.91); RR 1.21 (95% CI 1.08, 1.37), respectively]. NDDM patients had similar discharge LVEF to PDDM patients but lower than non-DM patients (MD -2.06% [95% CI -2.93, -1.18]). Their cardiometabolic profile resembled PDDM.</p><p><strong>Conclusions: </strong>Although the evidence was mostly low-certainty, the high prevalence of NDDM and its potentially unfavorable outcomes compared to non-DM patients could stimulate further research on the effects of intensified DM screening and preventive measures in the community and among ACS patients.</p><p><strong>Registration: </strong>This systematic review and meta-analysis was registered with PROSPERO (CRD42024501412).</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"317-326"},"PeriodicalIF":1.8000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Newly diagnosed versus previously diagnosed or no diabetes mellitus in patients with acute coronary syndrome: a systematic review and meta-analysis.\",\"authors\":\"Donatos Tsamoulis, Michail Papapanou, Dimitrios Platis, Timoleon Giannakas, Nikolaos Ktenopoulos, Loukianos S Rallidis\",\"doi\":\"10.1080/14779072.2025.2522225\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Νewly diagnosed diabetes mellitus (NDDM) among acute coronary syndrome (ACS) patients represents a distinct clinical entity, although available data remain inconclusive. This systematic review and meta-analysis compared ACS patients with NDDM to those without diabetes mellitus (DM) and those with previously diagnosed DM (PDDM).</p><p><strong>Methods: </strong>We searched PubMed, Scopus, and CENTRAL until 10 December 2024. We assessed myocardial necrosis, prognosis, coronary artery disease (CAD) extent, left ventricular ejection fraction (LVEF) at discharge, and cardiometabolic profiles. ROBINS-E and GRADE assessed bias risk and evidence certainty, respectively.</p><p><strong>Results: </strong>Out of 257,859 ACS patients from 34 studies, 5.2% had NDDM. NDDM patients had higher mean peak hs-cardiac troponin I levels compared to PDDM patients (MD 18,389.15 [95% CI 2975.96, 33802.34]) and intermediate post-discharge prognosis between PDDM and non-DM patients [5-MACE; RR 0.80 (95% CI 0.71, 0.91); RR 1.21 (95% CI 1.08, 1.37), respectively]. NDDM patients had similar discharge LVEF to PDDM patients but lower than non-DM patients (MD -2.06% [95% CI -2.93, -1.18]). Their cardiometabolic profile resembled PDDM.</p><p><strong>Conclusions: </strong>Although the evidence was mostly low-certainty, the high prevalence of NDDM and its potentially unfavorable outcomes compared to non-DM patients could stimulate further research on the effects of intensified DM screening and preventive measures in the community and among ACS patients.</p><p><strong>Registration: </strong>This systematic review and meta-analysis was registered with PROSPERO (CRD42024501412).</p>\",\"PeriodicalId\":12098,\"journal\":{\"name\":\"Expert Review of Cardiovascular Therapy\",\"volume\":\" \",\"pages\":\"317-326\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Expert Review of Cardiovascular Therapy\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1080/14779072.2025.2522225\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/6/28 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Expert Review of Cardiovascular Therapy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1080/14779072.2025.2522225","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/28 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
Νewly在急性冠脉综合征（ACS）患者中诊断为糖尿病（NDDM）代表了一个独特的临床实体，尽管现有数据仍不确定。本系统综述和荟萃分析比较了ACS合并NDDM患者与非糖尿病（DM）患者和既往诊断为DM （PDDM）患者。方法：检索PubMed、Scopus和CENTRAL，检索截止日期为2024年12月10日。我们评估了心肌坏死、预后、冠状动脉疾病（CAD）程度、出院时左心室射血分数（LVEF）和心脏代谢谱。ROBINS-E和GRADE分别评估偏倚风险和证据确定性。结果：在34项研究的257,859名ACS患者中，5.2%患有NDDM。与PDDM患者相比，NDDM患者的平均峰值心肌肌钙蛋白I水平更高（MD为18,389.15 [95% CI 2975.96, 33802.34]），并且PDDM与非dm患者的出院后预后处于中等水平[5-MACE；Rr 0.80 (95% ci 0.71, 0.91)；RR为1.21 （95% CI为1.08,1.37）。NDDM患者的出院LVEF与PDDM患者相似，但低于非dm患者（MD -2.06% [95% CI -2.93, -1.18]）。他们的心脏代谢谱与PDDM相似。结论：尽管证据大多是低确定性的，但与非糖尿病患者相比，NDDM的高患病率及其潜在的不利结果可以刺激进一步研究加强社区和ACS患者中糖尿病筛查和预防措施的效果。注册：该系统评价和荟萃分析已在PROSPERO注册（CRD42024501412）。
Newly diagnosed versus previously diagnosed or no diabetes mellitus in patients with acute coronary syndrome: a systematic review and meta-analysis.
Introduction: Νewly diagnosed diabetes mellitus (NDDM) among acute coronary syndrome (ACS) patients represents a distinct clinical entity, although available data remain inconclusive. This systematic review and meta-analysis compared ACS patients with NDDM to those without diabetes mellitus (DM) and those with previously diagnosed DM (PDDM).
Methods: We searched PubMed, Scopus, and CENTRAL until 10 December 2024. We assessed myocardial necrosis, prognosis, coronary artery disease (CAD) extent, left ventricular ejection fraction (LVEF) at discharge, and cardiometabolic profiles. ROBINS-E and GRADE assessed bias risk and evidence certainty, respectively.
Results: Out of 257,859 ACS patients from 34 studies, 5.2% had NDDM. NDDM patients had higher mean peak hs-cardiac troponin I levels compared to PDDM patients (MD 18,389.15 [95% CI 2975.96, 33802.34]) and intermediate post-discharge prognosis between PDDM and non-DM patients [5-MACE; RR 0.80 (95% CI 0.71, 0.91); RR 1.21 (95% CI 1.08, 1.37), respectively]. NDDM patients had similar discharge LVEF to PDDM patients but lower than non-DM patients (MD -2.06% [95% CI -2.93, -1.18]). Their cardiometabolic profile resembled PDDM.
Conclusions: Although the evidence was mostly low-certainty, the high prevalence of NDDM and its potentially unfavorable outcomes compared to non-DM patients could stimulate further research on the effects of intensified DM screening and preventive measures in the community and among ACS patients.
Registration: This systematic review and meta-analysis was registered with PROSPERO (CRD42024501412).
期刊介绍：
Expert Review of Cardiovascular Therapy (ISSN 1477-9072) provides expert reviews on the clinical applications of new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage includes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery. The Expert Review format is unique. Each review provides a complete overview of current thinking in a key area of research or clinical practice.
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