Admission Glucose Is a Useful Prognostic Factor in Patients with Acute Myocardial Infarction

급성 심근경색증 환자의 예후인자로서 내원 시 혈당의 유용성

  • Received : 2009.12.03
  • Accepted : 2010.05.11
  • Published : 2010.07.01

Abstract

Background/Aims: It has been suggested that admission hyperglycemia is associated with poor clinical outcomes in patients with acute myocardial infarction (AMI). The aim of this study was to assess the relationship between admission hyperglycemia and short-long term prognosis in patients with AMI. Methods: A total of 6,030 AMI patients without a previous history of diabetes were enrolled between Nov. 2005 and Jan. 2008. The patients were divided into three groups according to the levels of admission glucose levels: group I (<140 mg/dL, n=3,307), group II (140~199 mg/dL, n=1,946), and group III (${\geq}$200 mg/dL, n=777). In-hospital and one-year mortality were compared among three the groups. Results: The mean age was $64.3{\pm}13.3$, $65.9{\pm}12.7$, and $67.7{\pm}13.0$ years in group I, II and III, respectively. The proportion of female gender (23.9%, 29.5%, 35.0%; p<0.001), Killip class III-IV (8.9%, 12.3%, 28.3%; p<0.001), ST-segment elevation myocardial infarction (54.6%, 71.5%, 71.7%; p<0.001), and in-hospital mortality (3.5%, 7.5%, 19.7%; p<0.001) increased with higher tertiles of elevated values of initial serum glucose. Hazard ratio (HR) for mortality rate were significantly increased in group II [HR=1.19, 95% confidential interval (Cl) 1.02~1.40, p=0.032], and in group III [HR=1.91, 95% Cl 1.59~2.30, p=0.001], compared with group I. And also significant differences were existed between group II and group III [HR =1.55, 95% Cl 1.27~1.88, p=0.001]. Conclusions: Admission glucose in patients with AMI provides incremental prognostic value, and significantly correlates with in-hospital and one-year mortalities.

목적: 급성 심근경색증 환자에서 내원 당시 고혈당은 당뇨병의 유무와 관계없이 병원내 사망률을 증가시키고 예후가 나쁘다고 알려져 있으나 국내에서는 당뇨병을 동반하지 않은 급성 심근경색증 환자를 대상으로 내원 시 고혈당과 장단기 예후를 관찰한 연구가 미흡한 실정이다. 이에 본 연구에서는 급성 심근경색증 환자에서 내원 시 고혈당과 병원내 주요 임상 사건 및 사망률 그리고 1년 동안의 추적관찰을 통한 사망률을 알아보고자 하였다. 방법: 2005년 11월부터 2008년 1월까지 KAMIR에 등록된 14,870명의 급성 심근경색증 환자 중에서 당뇨병의 병력이 없고, 1년 동안의 추적관찰이 완료되어 분석 가능한 6,030명의 환자를 대상으로 하였다. 혈당 수치에 따라서 140 mg/dL 미만을 I군 3,307명($64.3{\pm}13.3$세, 여성 23.9%), 140 mg/dL 이상 200 mg/dL 미만을 II군 1,946명($65.9{\pm}12.7$세, 여성 29.5%), 200 mg/dL 이상을 III군 777명($67.7{\pm}13.0$세, 여성 35%)으로 분류하여 병원 내 주요 임상사건 및 1년 후 사망률과의 관계를 비교하였다. 결과: 위험인자에서 고혈압(p=0.001)과 흡연력(p=0.001), 현동반질환에서 심부전증(p=0.001)이 III군으로 갈수록 많았으며, 병원내 주요임상 사건에서는 심인성 쇼크(p=0.001), 심실성 빈맥증(p=0.001), 방실전도차단(p=0.001) 등과 입원 중 사망률(p=0.001)이 III군으로 갈수록 많았다. 위험인자를 보정한 Cox proportional anaylsis에서는 I군에 비해 II군에서 사망률이 유의하게 높았으며[Hazard ratio (HR)=1.19, 95% Cl(confidential interval) 1.02~1.40, p=0.032], I군에 비해 III군에서 사망률이 유의하게 높았다(HR=1.91, 95% Cl 1.59~2.30, p=0.001). II군과 III군 간의 비교에서도 II군에 비해 III군에서 사망률이 유의하게 높았다(HR=1.55, 95% Cl 1.27~1.88, p=0.001). 결론: 급성 심근경색증 환자의 내원 시 혈당이 높은 군으로 갈수록 입원 중 사망률 및 1년 후 사망률이 증가하였다.

Keywords

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