2型糖尿病患者心肌梗死后心血管结局及糖尿病病程的影响：一项全国性登记研究

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice Pub Date : 2025-08-07 DOI:10.1016/j.diabres.2025.112411

Anne M Kerola , Markus Juonala , Ville Kytö

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引用次数: 0

摘要

目的：研究2型糖尿病患者心肌梗死（MI）后的长期心血管预后。方法：从2004-2018年期间芬兰全国登记的心肌梗死合并2型糖尿病（n = 10,440）或非糖尿病（n = 65,315）患者中确定存活90 天的患者。主要结局是主要心血管不良事件(MACE；复发性心肌梗死、缺血性卒中、心力衰竭住院或心血管死亡)，采用竞争风险细灰色分析进行研究。中位（最长）随访时间为3.7（12）年。通过多变量调整和倾向评分匹配来平衡组间差异（n = 10,300对患者）。结果：2型糖尿病患者12年累积MACE发生率（68.8% %）高于倾向评分匹配的无糖尿病患者（56.1% %）(亚分布风险比[sHR]: 1.36；95 % ci: 1.31-1.41)。复发性心肌梗死发生率(sHR 1.49；95 % CI 1.41-1.57)，缺血性卒中(1.14；1.05-1.23)，心力衰竭住院(1.48；1.40-1.57)，心血管死亡(1.30；1.24-1.36)在2型糖尿病患者中较高。较长的糖尿病病程与MACE、复发性心肌梗死、心力衰竭和心血管死亡相关。结论：心肌梗死后2型糖尿病患者的长期心血管预后受损，强调了有效二级预防的重要性。糖尿病病程较长的患者风险特别高。

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Cardiovascular outcomes of patients with type 2 diabetes after myocardial infarction and the impact of diabetes duration: a nationwide registry study

Aims

To study long-term cardiovascular outcomes following a myocardial infarction (MI) among patients with type 2 diabetes.

Methods

Patients surviving 90 days after MI with type 2 diabetes (n = 10,440) or without diabetes (n = 65,315) during 2004–2018 were identified from Finnish nationwide registries. The primary outcome, a major adverse cardiovascular event (MACE; recurrent MI, ischemic stroke, heart failure hospitalization, or cardiovascular death), was studied using competing risk Fine-Gray analyses. Median (maximum) follow-up was 3.7 (12) years. Differences between groups were balanced by multivariable adjustments and propensity score matching (n = 10,300 patient pairs).

Results

12-year cumulative incidence of MACE was higher in patients with type 2 diabetes (68.8 %) compared to propensity score-matched patients without diabetes (56.1 %) (sub-distribution hazard ratio [sHR]: 1.36; 95 % CI: 1.31–1.41). Incidences of recurrent MI (sHR 1.49; 95 % CI 1.41–1.57), ischemic stroke (1.14; 1.05–1.23), heart failure hospitalization (1.48; 1.40–1.57), and cardiovascular death (1.30; 1.24–1.36) were higher in patients with type 2 diabetes. Longer diabetes duration was associated with MACE, recurrent MI, heart failure, and cardiovascular death.

Conclusions

Patients with type 2 diabetes have impaired long-term cardiovascular outcomes after an MI, underlining the importance of effective secondary prevention. Patients with a longer diabetes duration are at a particularly high risk.

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来源期刊

Diabetes research and clinical practice 医学-内分泌学与代谢

CiteScore

10.30

自引率

3.90%

发文量

862

审稿时长

32 days

期刊介绍： Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.