This study aimed to investigate the clinical features and prognosis of diabetes and myocardial injury in patients admitted to the emergency department. We analyzed the clinical data of all consecutive patients admitted to the emergency department during the years 2012 and 2013 with at least 1 cardiac Troponin I (cTnI Ultra Siemens, Advia Centaur) determination, and were classified according to the status of diabetes mellitus (DM) and myocardial injury (MI). Clinical events were evaluated in a 4-year follow-up. A total of 3622 patients were classified according to the presence of DM (n = 924 (25.55%)) and MI (n = 1049 (28.96%)). The proportion of MI in patients with DM was 40% and 25% in patients without DM. Mortality during follow-up was 10.9% in non-DM patients without MI, 21.3% in DM patients without MI, 40.1% in non-DM patients with MI, and 52.8% in DM patients with MI. A competitive risk model was used to obtain the Hazard Ratio (HR) for readmission for myocardial infarction or heart failure. There was a similar proportion of readmission for myocardial infarction and heart failure at a four-year follow-up in patients with DM or MI, which was much higher when DM was associated with MI, with respect to patients without DM or MI. The HR (95% Coefficient Interval) for myocardial infarction in the DM without MI, non-DM with MI, and DM with MI groups with respect to the non-DM without MI group was 2511 (1592–3960), 2682 (1739–4138), and 5036 (3221–7876), respectively. The HR (95% CI) for the risk of readmission for heart failure in the DM without MI, non-DM with MI, and DM with MI groups with respect to the non-DM without MI group was 2663 (1825–3886), 2562 (1753–3744) and 4292 (2936–6274), respectively. The association of DM and MI in patients treated in an Emergency Service identifies patients at very high risk of mortality and cardiovascular events.

中文翻译：

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急诊室患者糖尿病和心肌损伤的临床特征和预后意义


本研究旨在探讨急诊科收治的糖尿病合并心肌损伤患者的临床特征和预后。我们分析了 2012 年和 2013 年期间入院急诊科并至少进行 1 次心肌肌钙蛋白 I（cTnI Ultra Siemens、Advia Centaur）测定的所有连续患者的临床数据，并根据糖尿病 (DM) 状态进行分类和心肌损伤（MI）。临床事件在 4 年随访中进行评估。根据是否存在 DM (n = 924 (25.55%)) 和 MI (n = 1049 (28.96%)) 对总共 3622 名患者进行分类。 DM 患者中 MI 的比例为 40%，非 DM 患者中 MI 的比例为 25%。随访期间，不伴 MI 的非糖尿病患者的死亡率为 10.9%，不伴 MI 的 DM 患者的死亡率为 21.3%，伴 MI 的非DM 患者的死亡率为 40.1%，伴 MI 的 DM 患者的死亡率为 52.8%。使用竞争风险模型来获得因心肌梗塞或心力衰竭再次入院的风险比（HR）。在四年的随访中，糖尿病或心肌梗死患者因心肌梗塞和心力衰竭再入院的比例与无糖尿病或心肌梗死的患者相比相似，当糖尿病与心肌梗死相关时，这一比例要高得多。不伴 MI 的 DM 组、伴 MI 的非 DM 组、伴 MI 的 DM 组相对于不伴 MI 的非 DM 组，心肌梗死的 HR（95% 系数区间）分别为 2511（1592-3960）、2682（1739-分别为 4138）和 5036（3221-7876）。不伴 MI 的 DM 组、伴 MI 的非 DM 组和伴 MI 的 DM 组中，相对于不伴 MI 的非 DM 组，因心力衰竭再入院的风险 HR (95% CI) 为 2663 (1825–3886)，分别为 2562 (1753–3744) 和 4292 (2936–6274)。 在急诊服务中接受治疗的患者中，DM 和 MI 的相关性表明患者的死亡和心血管事件风险非常高。