急性心肌梗死高血糖的控制课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,急性心肌梗死高血糖的控制,此处添加副标题内容,急性心肌梗死高血糖的控制急性心肌梗死高血糖的控制此处添加副标题内容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,情亲,急性心肌梗死高血糖的控制此处添加副标题内容急性心肌梗死高血糖,1,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,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,2,急性心肌梗死高血糖的控制课件,3,欧洲心脏调查结果-分组,n=2107,n=2854,The Euro Heart Survey on diabetes and the heart，European Heart Journal(2019)25,18801890,欧洲心脏调查结果-分组n=2107n=2854The Eur,4,GAMI:,急性心梗患者中的糖代谢异常,心肌梗死患者,Bartnik M,et al.J Intern Med.2019 Oct;256(4):288-97.,GAMI:急性心梗患者中的糖代谢异常心肌梗死患者Bartni,5,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,Bartnik M,et al.Eur Heart J.2019;25(22):1990-7.,中位数随访时间:34月,GAMI:新诊断高血糖是心肌梗死后“无心血管事件存活”的,6,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.,Diabetics with a non-ST elevat,7,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 2019;339:229.,Diabetes increases coronary mo,8,Hyperglycemia and Outcome After Acute MI,Predictive Value of Admission Glucose,Fasting glucose within 24hrs of admission,HbA1c on admission,U-shaped curve,Hyperglycemia and Outcome Afte,9,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 13 mmol/L,234 to 297 mg/dL 13 to 16.5 mmol/L,and 297 mg/dL 16.5 mmol/L)(p 0.001).The mortality in those treated with intensive insulin was significantly reduced(33 versus 44 percent in the control group)regardless of the blood glucose value at admission.Data from Malmberg,K,Norhammar,A,Wedel,H,Ryden,L,Circulation 2019;99:2626.,Intensive insulin therapy redu,10,Relationship between admission glucose values andcrude 30-day and 1-year mortality in all patients,Admission glucose and mortality in elderly patients hospitalized with acute MI:implications for patients with recognized diabetes Circulation 2019;111;3078,Relationship between admission,11,Direct comparison of risk-adjusted 30-day mortality in patients with and without recognized diabetes across range of glucose values.,Adminission glucose and mortality in elderly patients hospitalized with acute MI:implications for patients with recognized diabetes,Circulation 2019;111;3078,30-day Mortality,Direct comparison of risk-adju,12,One-Year Mortality,Direct comparison of risk-adjusted 1-year mortality in patients with and without recognized diabetes across range of glucose values,Adminission glucose and mortality in elderly patients hospitalized with acute MI:implications for patients with recognized diabetes,Circulation 2019;111;3078,One-Year MortalityDirect compa,13,Figure1:Kaplan-meier cumulative survival curves of patients with normal FG and tertiles of elevated FG,Fasting glucose is an important independent risk factor for 30-day mortality in patients with AMI:a prospective study Circulation 2019;111:754,Figure1:Kaplan-meier cumulativ,14,U-shaped curve,血糖水平与30天死亡率,低血糖组：11.0mmol/L,U-shaped relationship of blood glucose with adverse outcomes among patients with ST-segment elevation myocardial infarction,J Am Coll Cardiol 2019;46:178,U-shaped curve血糖水平与30天死亡率低血糖组,15,U-shaped curve,血糖水平与30天内再发心梗或死亡率,低血糖组：11.0mmol/L,U-shaped relationship of blood glucose with adverse outcomes among patients with ST-segment elevation myocardial infarction,J Am Coll Cardiol 2019;46:178,U-shaped curve血糖水平与30天内再发心梗或死,16,Predictive value of HbA,1,c,Relation of chronic and acute glycemic control on mortality in acute MI with DM,Am J Cardiol 2019;96:183,HbA,1,c on admission may,NOT,independently,predict mortality,this observation suggest that stress hyperglycemia is of primary importance,Predictive value