Impact of insulin resistance on prognosis in non-diabetic patients with acute coronary syndromes
10.3760/cma.j.issn.0253-3758.2013.07.009
- VernacularTitle:胰岛素抵抗对非糖尿病急性冠状动脉综合征患者预后的影响
- Author:
Ru-Qiong NIE
1
;
Jia-Rong LIU
;
Bing-Qing DENG
;
Shuang-Lun XIE
;
Jing-Feng WANG
Author Information
1. 中山大学孙逸仙纪念医院心内科
- Keywords:
Coronary diseases;
Insulin resistance;
Prognosis
- From:
Chinese Journal of Cardiology
2013;41(7):559-562
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the impact of insulin resistance (IR) on prognosis in nondiabetic acute coronary syndrome patients.Methods In this prospective study,we enrolled 332 nondiabetic patients suffering from acute coronary syndrome.The patients were divided into three groups by HOMA-IR which calculated by formula:low HOMA-IR group (HOMA-IR ＜ 2),44 cases; moderate HOMA-IR group (2 ≤ HOMA2-IR ＜ 6),99 cases; high HOMA-IR group (HOMA≥6) with HOMA index,179 cases.The in-hospital medical records of patients were compared,and all patients were followed up for one year after discharge.Results Incidence of hypertension (P =0.013),dyslipidemia (P ＜ 0.001),faster resting heart rate (P ＜0.001) and number of triple vessel coronary artery disease (P =0.017)in high HOMA-IR group were significantly higher than in low and moderate HOMA-IR group.During follow-up,the major end-point events increased in proportion to IR grade:64.3％ (26/44) in the high HOMA-IR group,54.7％ (52/99)in moderate HOMA-IR group and 41.3％ (74/199)in low HOMA-IR group (P =0.034).Multivariable logistic regression analysis showed that high sensitivity C reactive protein(OR =1.012,95％CI:1.002-1.022,P =0.022),HOMA-IR (OR =1.250,95％ CI:1.043-1.497,P =0.015),triple vessel coronary artery disease (OR =5.914,95％ CI:2.947-11.868,P ＜ 0.001),ischemic changes on ECG(OR =5.495,95％ CI:2.925-10.324,P ＜ 0.001) and low left ventricular ejection fraction (LVEF ≤40％) (OR =13.205,95％ CI:5.000-34.661,P ＜ 0.001) were independent risk factor for major end-point events during follow-up.Conclusions Increased insulin resistance is linked with poor prognosis of nondiabetic patients with acute coronary syndrome.
