Admission hyperglycemia as an independent predictor of long‐term prognosis in acute myocardial infarction patients without diabetes: A retrospective study

Cui, Cai-Yan; Zhou, Ming-Gang; Cheng, Lian-Chao; Tao, Ye; Zhang, Yumei; Zhu, Feng; Li, Siyi; Jiang, Xinglin; Chen, Qiang; Qi, Lingyao; Chen, Xu; Yang, Siqi; Cai, Lin

doi:10.1111/jdi.13468

Cited by 27 publications

(24 citation statements)

References 31 publications

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“…Recent literature defined hyperglycemia as serum glucose in the range between >122 mg/dL. [42] up to >198 mg/dL [41], which may result in a diverse distribution of subjects per groups in these studies. Secondly, a lower proportion of patients without known diabetes received insulin during hospitalization compared with diabetics, even with severe hyperglycemia.…”

Section: Discussionmentioning

confidence: 99%

3-year mortality after acute myocardial infarction in patients with different diabetic status

Fojt¹,

Kowalik²,

Gierlotka³

et al. 2021

Polish Archives of Internal Medicine

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Worse prognosis has been observed in patients with myocardial infarction (MI) and previously diagnosed diabetes mellitus (DM), new-onset DM and transient hyperglycemia compared with their non-diabetic counterparts. Many studies concerning treatment results were, however, conducted during the thrombolytic era. Relatively little is known about the outcomes of patients with elevated glucose levels during hospitalization without previous DM diagnosis or patients with new-onset DM. Our study, therefore, enclosed two additional classifications for acute MI patients in regard to glycemia status during hospitalization. We evaluated a nationwide prospective cohort of over 58 thousand MI patients in terms of inhospital complications and long-term outcomes over a three-year period per different carbohydrate disorder type: DM type 1, DM type 2, new-onset DM and transient hyperglycemia. In contrast with previous publications, this article is not only limited to admission glucose levels but includes full glycemia monitoring throughout hospitalization.

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Section: Discussionmentioning

confidence: 99%

3-year mortality after acute myocardial infarction in patients with different diabetic status

Fojt¹,

Kowalik²,

Gierlotka³

et al. 2021

Polish Archives of Internal Medicine

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“…In addition, the information on glycaemic status can be useful beyond prediction for shortterm prognosis. Admission glucose is an independent predictor of long-term prognosis in non-diabetic AMI patients [42]. Interestingly, glucose variability between visits to clinic is associated with adverse cardiac remodeling after STEMI, suggesting that the clinical value of glucose and its related parameters is significant and should be investigated further [43].…”

Section: Shr and Glucose As Clinical Outcome Predictorsmentioning

confidence: 99%

Optimal glucose, HbA1c, glucose-HbA1c ratio and stress-hyperglycaemia ratio cut-off values for predicting 1-year mortality in diabetic and non-diabetic acute myocardial infarction patients

Sia

Chan

Zheng

et al. 2021

Cardiovasc Diabetol

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Background Stress-induced hyperglycaemia at time of hospital admission has been linked to worse prognosis following acute myocardial infarction (AMI). In addition to glucose, other glucose-related indices, such as HbA1c, glucose-HbA1c ratio (GHR), and stress-hyperglycaemia ratio (SHR) are potential predictors of clinical outcomes following AMI. However, the optimal blood glucose, HbA1c, GHR, and SHR cut-off values for predicting adverse outcomes post-AMI are unknown. As such, we determined the optimal blood glucose, HbA1c, GHR, and SHR cut-off values for predicting 1-year all cause mortality in diabetic and non-diabetic ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients. Methods We undertook a national, registry-based study of patients with AMI from January 2008 to December 2015. We determined the optimal blood glucose, HbA1c, GHR, and SHR cut-off values using the Youden’s formula for 1-year all-cause mortality. We subsequently analyzed the sensitivity, specificity, positive and negative predictive values of the cut-off values in the diabetic and non-diabetic subgroups, stratified by the type of AMI. Results There were 5841 STEMI and 4105 NSTEMI in the study. In STEMI patients, glucose, GHR, and SHR were independent predictors of 1-year all-cause mortality [glucose: OR 2.19 (95% CI 1.74–2.76); GHR: OR 2.28 (95% CI 1.80–2.89); SHR: OR 2.20 (95% CI 1.73–2.79)]. However, in NSTEMI patients, glucose and HbA1c were independently associated with 1-year all-cause mortality [glucose: OR 1.38 (95% CI 1.01–1.90); HbA1c: OR 2.11 (95% CI 1.15–3.88)]. In diabetic STEMI patients, SHR performed the best in terms of area-under-the-curve (AUC) analysis (glucose: AUC 63.3%, 95% CI 59.5–67.2; GHR 68.8% 95% CI 64.8–72.8; SHR: AUC 69.3%, 95% CI 65.4–73.2). However, in non-diabetic STEMI patients, glucose, GHR, and SHR performed equally well (glucose: AUC 72.0%, 95% CI 67.7–76.3; GHR 71.9% 95% CI 67.7–76.2; SHR: AUC 71.7%, 95% CI 67.4–76.0). In NSTEMI patients, glucose performed better than HbA1c for both diabetic and non-diabetic patients in AUC analysis (For diabetic, glucose: AUC 52.8%, 95% CI 48.1–57.6; HbA1c: AUC 42.5%, 95% CI 37.6–47. For non-diabetic, glucose: AUC 62.0%, 95% CI 54.1–70.0; HbA1c: AUC 51.1%, 95% CI 43.3–58.9). The optimal cut-off values for glucose, GHR, and SHR in STEMI patients were 15.0 mmol/L, 2.11, and 1.68 for diabetic and 10.6 mmol/L, 1.72, and 1.51 for non-diabetic patients respectively. For NSTEMI patients, the optimal glucose values were 10.7 mmol/L for diabetic and 8.1 mmol/L for non-diabetic patients. Conclusions SHR was the most consistent independent predictor of 1-year all-cause mortality in both diabetic and non-diabetic STEMI, whereas glucose was the best predictor in NSTEMI patients.

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“…Clinical studies have confirmed that increased blood glucose levels in the infarct area accelerate anaerobic glycolysis, leading to the production of a large number of acidic metabolites, which cause local paralysis and dilation of blood vessels and damage to the vascular endothelium. Elevated blood glucose level will increase the aggregation ability of red blood cells, reduce the blood flow rate, and promote platelet aggregation and adhesion, leading to the formation of thrombus [ 22 ]. The linear regression equation is the use of regression analysis in mathematical statistics to determine the interdependent quantitative relationship between two or more variables, where r is a statistical indicator first designed by Carl Pearson to indicate the amount of linear correlation between the studied variables, and r ≥ 0.8 is regarded as highly correlated [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Correlation between Selection of Time Window for Acute Cerebral Infarction and Efficacy of Intravascular Stent Implantation

Feng

Gong²

2022

Journal of Healthcare Engineering

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Objective. To explore the correlation between selection of time window for acute cerebral infarction (ACI) and efficacy of intravascular stent implantation. Methods. The clinical data of 84 ACI patients treated in our hospital from March 2019 to March 2020 were selected for the retrospective analysis, all study subjects received intravascular stent implantation, and after discharge, patients were assessed by the Modified Rankin Scale (mRS) and divided into the good prognosis group (n = 46, mRS score ≤2 points) and poor prognosis group (n = 38, mRS score >2 points). The clinical data of patients in the two groups at admission underwent univariate analysis, the indicators presenting P < 0.05 were included in the logistic regression model, and the correlation between patients’ treatment time window and clinical effect was analyzed by multivariate logistic regression analysis and linear fitting analysis. Results. According to the multivariate logistic regression analysis, low-density lipoprotein (LDL), time window, and blood glucose level before treatment were the independent factors affecting patients’ treatment effect and were associated with the efficacy of intravascular stent implantation (r was 0.790, 0.889, and 0.672, respectively). Conclusion. LDL, time window, and blood glucose level before treatment are the important factors affecting the efficacy of intravascular stent implantation for ACI patients, among which the time window is most significantly associated with the clinical effect. Therefore, ACI patients should accept clinical treatment as early as possible.

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Admission hyperglycemia as an independent predictor of long‐term prognosis in acute myocardial infarction patients without diabetes: A retrospective study

Cited by 27 publications

References 31 publications

3-year mortality after acute myocardial infarction in patients with different diabetic status

3-year mortality after acute myocardial infarction in patients with different diabetic status

Optimal glucose, HbA1c, glucose-HbA1c ratio and stress-hyperglycaemia ratio cut-off values for predicting 1-year mortality in diabetic and non-diabetic acute myocardial infarction patients

Correlation between Selection of Time Window for Acute Cerebral Infarction and Efficacy of Intravascular Stent Implantation

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