目的：评价糖化血红蛋白(glycosylated hemoglobin，HbA1c)对老年急性心肌梗死患者接受直接经 皮冠脉介入治疗远期预后的影响。方法：入选2008年6月31日~2012年12月31日在我院接受直接经 皮冠脉介入治疗，年龄60岁以上，入院后24小时内测定HbA1c并且出院后随访>1年的急性心肌梗 死患者233例，根据HbA1c水平分为3组，组I(HbA1c ≤5.6%，46例)、组II(5.7%≤ HbA1c ≤6.4%， 92例)、组III(HbA1c ≥6.5%，95例)。分析三组患者1年内主要不良心脏事件(main adverse cardiac events，MACE)和全因死亡率，了解患者入院后HbA1c水平与急性心肌梗死1年以上长期预后的关 系。结果：临床随访平均(977±438) d，随访1年死亡12例(5.2%)，发生不良心脏事件18例(7.7%)。 将入选患者分为否认糖尿病组和糖尿病组，否认糖尿病组患者1年内MACE发生率与死亡率三组 均一致，组III(12.5%)明显高于组II(2.6%)和组I(0%；P=0.026)，但组I与组II之间无明显差异；糖 尿病组患者将组I与组II合并后与组III比较在1年内的MACE发生率(P=0.059)及死亡率(P=0.328)上 无统计学差异。多因素Cox回归分析，校正其他因素后，HbA1c是患者长期(1年以上)死亡率的独 立预测因子(HR: 1.258；95% CI: 1.114~1.421；P<0.001)。结论：在接受直接经皮冠状动脉介入治 疗的老年急性心肌梗死患者，HbA1c是长期死亡发生的独立预测因子。对于既往无糖尿病病史患 者，HbA1c ≥6.5%与其1年内发生死亡和主要心脏不良事件显著相关。
Influence of glycosylated hemoglobin on long-term prognosis of elderly patients with acute myocardial infarction treated with percutaneous coronary intervention
Objective: To evaluate the influence of glycosylated hemoglobin (HbA1c) on long-term prognosis of elderly patients with acute myocardial infarction treated with primary percutaneous coronary intervention (PCI). Methods: A total of 233 acute myocardial infarction patients with age ≥60 years old who received primary PCI during June 2008 to December 2012 and followed up >1 year after charge were included in this study. Blood sample for HbA1c were obtained on the first 24 h after admission. Patients were classified into three groups: group I (HbA1c ≤5.6%; n=46); group II (5.7%≤ HbA1c ≤6.4%; n=92); and group III (HbA1c ≥6.5%; n=95). Results: The patients were followed up for a mean period of (977±438) days. Totally 12 patients (5.2%) died and MACE occurred in 18 patients (7.7%).The patients were divided into diabetes group and diabetes-denied group. MACE and mortality in one year which were equal in diabetes-denied was higher in group III (12.5%) compared with group II (2.6%) and group I (0%; P=0.026), but there were not different between group II and group I. In diabetes group, group I and group II were merged to compare with group III, the differences of MACE and mortality in one year were not found between them in the result. After multivariate analysis, HbA1c (hazard ratio, 1.258; 95% CI: 1.114-1.421; P<0.001) was independently associated with long-term (more than 1 year) mortality. Conclusion: The HbA1c is an independent predictor of long-term outcomes in elderly patients with acute myocardial infarction treated with primary PCI. HbA1c ≥6.5 were associated with MACE and mortality in 1 year for the diabetes-denied patients.