An Elevated Glycemic Gap is Associated with Adverse Outcomes in Diabetic Patients with Acute Myocardial Infarction

Abstract

Acute hyperglycemia is a frequent finding in patients presenting to the emergency department (ED) with acute myocardial infarction (AMI). The prognostic role of hyperglycemia in diabetic patients with AMI remains controversial. We retrospectively reviewed patients’ medical records to obtain demographic data, clinical presentation, major adverse cardiac events (MACEs), several clinical scores and laboratory data, including the plasma glucose level at initial presentation and HbA1c levels. The glycemic gap, which represents changes in serum glucose levels during the index event, was calculated from the glucose level upon ED admission minus the HbA1c-derived average glucose (ADAG). We enrolled 331 patients after the review of medical records. An elevated glycemic gap between admission serum glucose levels and ADAG were associated with an increased risk of mortality in patients. The glycemic gap showed superior discriminative power regarding the development of MACEs when compared with the admission glucose level. The calculation of the glycemic gap may increase the discriminative powers of established clinical scoring systems in diabetic patients presenting to the ED with AMI. In conclusion, the glycemic gap could be used as an adjunct parameter to assess the severity and prognosis of diabetic patients presenting with AMI. However, the usefulness of the glycemic gap should be further explored in prospective longitudinal studies.

Relative hyperglycemia is associated with complications following an acute myocardial infarction: a post-hoc analysis of HI-5 data

“…Others have reported that relative hyperglycemia at admission to hospital has been associated with poor outcomes in patients with acute illness [ 10 ], stroke [ 9 ], acute myocardial infarction [ 30 , 32 ] and in cardiogenic shock [ 33 ]. In addition to SHR two other measures of relative glycemia have been proposed.…”

“…The “glycemic gap” is the difference between the admission glucose and the estimated average glucose i.e. it is the absolute rather than the relative difference in glucose concentration [ 11 , 32 , 34 ]. Another proposal was for a “glucose concentration-to-HbA1c ratio”, in which the admission glucose is divided by the HbA1c [ 9 ].…”

Glycine Protects H9C2 Cardiomyocytes from High Glucose- and Hypoxia/Reoxygenation-Induced Injury via Inhibiting PKCβ2 Activation and Improving Mitochondrial Quality

“…Acute myocardial infarction (AMI) is one of the leading causes of death in patients with diabetes [ 1 ]. Hyperglycemia-induced oxidative stress plays a vital role in the development and progression of AMI [ 2 ].…”

Stress-Induced Hyperglycemia in Diabetes: A Cross-Sectional Analysis to Explore the Definition Based on the Trauma Registry Data

“…One explanation is that patients with diabetes are more adapted to a chronic and premorbid hyperglycemic environment than those patients without diabetes, who may not handle acute hyperglycemia in critical illnesses well [ 15 ]. Another plausible explanation for the inconsistent results is the lack of consideration of patients’ premorbid hyperglycemia in many reports, especially in patients with diabetes [ 16 , 17 , 18 ]. Furthermore, SIH and DH are not mutually exclusive entities, as DH patients may have some degree of stress response, invoking their hyperglycemia.…”

“…In an international multicenter study, the long-term average glucose levels were estimated by converting HbA1c values into A1c-derived average glucose (ADAG), using the equation, ADAG = ((28.7 × HbA1c) − 46.7) [ 21 , 22 ], which presented a strong correlation between HbA1c and mean plasma glucose levels in the preceding 3 months. Some glycemic variables, after adjusting for ADAG, are useful in the assessment of adverse outcomes in patients with diabetes [ 16 , 17 , 18 ]. For example, glycemic gap, the admission glucose level minus ADAG, indicates elevated glucose levels in diabetes patients with critical illnesses.…”