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To predict the independent risk factors in patients with coronary heart disease accompanied with type 2 diabetes mellitus who attacked acute myocardial infarction.
In this study, 7892 cases with coronary heart disease were enrolled in seven provinces. Basic information such as age, gender, height, weight, waist circumference, body mass index (BMI), the highest systolic blood pressure, the highest diastolic blood pressure, triglyceride, low density lipoprotein, high density lipoprotein, total cholesterol, fasting blood glucose, 2 hour postprandial blood glucose, glycosylated hemoglobin; the disease course, type and Canadian Cardiovascular Society (CCS) classification of coronary heart disease; treatment methods such as percutaneous coronary intervention (PCI) surgery, coronary artery bypass graft (CABG) or drug treatment: insulin, metformin, nitrates, calcium antagonists, trimetazidine, nicorandil, aspirin, clopidogrel, angiotensin-converting enzyme inhibitor (ACEI), and angiotensin receptor blockers (ARB); lifestyle such as moderate intensity exercise, smoking, and drink; comorbidity such as hyperhomocysteinemia, hyperuricemia, cardiovascular disease, cancer, stroke or transient ischemic attack (TIA), peripheral vascular disease were recorded. The patients were followed up for 3.5 years. Multivariate logistic regression analysis was used to identify independent predictors and COX regression was used to analyze the influencing factors of survival in acute myocardial infarction in type 2 diabetes mellitus.
In total 7892 patients with coronary heart disease, 1824 cases were diabetic patients including 363 cases of myocardial infarction, 536 cases of unstable angina, 502 cases of stable angina, 502 cases of asymptomatic myocardial ischemia in 271 patients, 123 patients with ischemic cardiomyopathy. The cases of acute myocardial infarction with diabetes mellitus were 145. Multivariate logistic regression analysis showed that age, male, high diastolic blood pressure, fast blood glucose, high low density lipoprotein, high total cholesterol, lower high density lipoprotein, CCS grade and smoking were independent risk factors in acute myocardial infarction in patients with coronary heart disease accompanied with type 2 diabetes. CABG and PCI significantly reduced angina pectoris compared with drug treatment. In the patients who attacked myocardial infarction with type 2 diabetes, COX regression showed that patients with sufficient ratio of utility ratio of medication, antiplatelet agents, lipid-lowering drugs, beta blockers, ACEI, and ARB, in secondary prevention of coronary heart disease had a higher survival rate.
The risk prediction model of myocardial infarction in patients with coronary heart disease accompanied with type 2 diabetic was composed of 9 factors: age, gender, blood pressure, blood glucose, blood lipid, smoking, drug compliance rate, complicated disease, and CCS grade were risk factors for acute myocardial infarction in patients with type 2 diabetes mellitus. Normalized blood glucose, blood lipids and blood pressure, sufficient secondary prevention medication, and control of complicated diseases could improve the survival rate of patients attacked acute myocardial infarction with coronary heart disease accompanied with type 2 diabetes.