Association of stress induced hyperglycemia with angiographic findings and clinical outcomes in patients with ST-elevation myocardial infarction

Abstract

Background Stress induced hyperglycemia (SIH) is common among patients with ST-elevation myocardial infarction (STEMI), even in patients without diabetes mellitus. However, evidence regarding its role on the angiographic outcomes and the prognosis of patients presenting with STEMI is scarce. Methods This study included 309 consecutively enrolled STEMI patients undergoing primary percutaneous coronary intervention (pPCI). Patients were diagnosed with SIH if blood glucose on admission was > 140 mg/dl. Also, patients had to fast for at least 8 hours before blood sampling. The objective was to assess whether SIH was associated with major adverse cardiovascular and cerebrovascular (MACCE) events and explore its relationship with angiographic predictors of worse prognosis such as poor initial TIMI flow, intracoronary thrombus burden, distal embolization, and presence of residual thrombus after pPCI. Results SIH in diabetic and non-diabetic patients was associated with a higher incidence of LTB (aOR = 2.171, 95% CI 1.27–3.71), distal embolization (aOR = 2.71, 95% CI 1.51–4.86), and pre-procedural TIMI flow grade = 0 (aOR = 2.69, 95% CI 1.43–5.04) after adjusting for relevant clinical variables. Importantly, during a median follow-up of 1.7 years STEMI patients with SIH with or without diabetes experienced increased occurrence of MACCE both in univariate (HR = 1.92, 95% CI 1.19–3.01) and multivariate analysis (aHR = 1.802, 95% CI 1.01–3.21). Conclusions SIH in STEMI patients with or without diabetes was independently associated with increased MACCE. This could be attributed to the fact that SIH was strongly correlated with poor pre-procedural TIMI flow, LTB, and distal embolization. Large clinical trials need to validate SIH as an independent predictor of adverse angiographic and clinical outcomes to provide optimal individualized care for patients with STEMI.

Prognostic implication of stress hyperglycemia in patients with acute coronary syndrome undergoing percutaneous coronary intervention

“…Stress hyperglycemia has been documented as a strong predictor of adverse outcomes in patients with ACS. It has been reported that stress hyperglycemia is significantly associated with major adverse cardiovascular and cerebrovascular events, irrespective of the diabetes status in STEMI patients undergoing PCI [ 5 ]. In addition, stress hyperglycemia ratio (SHR), representing relative hyperglycemia using the ratio of the admission blood glucose to estimated chronic blood glucose, is significantly related to in-hospital mortality in patients with coronary artery disease, especially for those with prediabetes and diabetes [ 30 ].…”

Association of stress hyperglycemia with clinical outcomes in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention: a cohort study

“…In acute coronary syndrome, Pasquale et al followed 2704 patients with acute myocardial infarction for a mean period of 26 months, finding a significant positive association between ABG and in-hospital as well as all-cause mortality, regardless of diabetes mellitus status [ 6 ]. Nikolaos et al conducted a study involving 309 consecutive patients with STEMI, with the primary endpoint being adverse cardiovascular and cerebrovascular events over a median follow-up period of 1.7 years [ 8 ]. The study found that ABG was independently associated with an increased risk of major cardiovascular events.…”

Estrategia De Enfermería Para Disminuir Ansiedad Del Paciente en Procedimientos Endoscopicos: Ensayo Clínico Aleatorizado

“…A pesar de que los niveles de glucosa en la sangre y producción alterada de insulina, es otra de las respuestas metabólicas alteradas que reporta la literatura y que ocurren frente al estrés agudo (34) , los hallazgos del presente estudio no coinciden con estudios anteriores, ya que no se advirtió aumento en valores de glicemias, como tampoco diferencias significativas (p> 0,005). Estos resultados contrastan con algunos autores que indicaron que la hiperglicemia de estrés es una alteración que se presenta frecuentemente en sujetos enfermos que no tienen diabetes (35) , mientras que otros estudios relacionaron valores altos de glicemia con mayores tasas de complicaciones postoperatorias en pacientes no diabéticos quirúrgicos (36) . Los resultados del presente estudio, con respecto al comportamiento de la glicemia pudieran deberse, por un lado, a que gracias a la gestión de asegurar un acompañamiento significativo a los pacientes, favoreció a que estos pacientes presentaran valores "bajos" y "bajo el promedio" de ansiedad, logrando de esta forma, disminuir o atenuar la hiperglicemia de estrés.…”