Editorial: Hyperglycemia and Coronary Artery Diseases: Physio-Pathological Findings and Therapeutic Implications

Marfella, Raffaele; Federici, Massimo; Paolisso, Giuseppe

doi:10.3389/fphar.2022.901815

Cited by 6 publications

(3 citation statements)

References 28 publications

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“…Both hyperglycemia and hypoglycemia, along with glycemic variability, play critical roles in determining AMI patient outcomes (21)(22)(23)(24). While hyperglycemia may intensify oxidative stress and in ammatory responses, hindering cardiac repair and leading to endothelial dysfunction (25,26), hypoglycemia is linked to heightened platelet activity and coagulation anomalies, introducing additional risks (27,28). These ndings emphasize the importance of precise glycemic monitoring and management in AMI patients and the delicate balance needed to improve patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Glycemic Comparison Index (GCI): A Retrospective Analysis of its Prognostic Value in ICU Patients with AMI and Diabetes

She,

Wang,

et al. 2024

Preprint

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Background: Acute myocardial infarction (AMI) significantly impacts global health, particularly in individuals with diabetes, highlighting the necessity for specialized glycemic management. This study introduces the Glycemic Comparison Index (GCI), a novel prognostic tool for AMI patients with diabetes, aiming to improve glucose management in critical care. Methods: A single-center retrospective analysis was conducted using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, focusing on ICU patients with concurrent AMI and diabetes. GCI was calculated by comparing mean blood glucose levels in the ICU to baseline glucose levels, with patients stratified into tertiles based on their GCI scores. The primary outcome assessed was one-year all-cause mortality, with secondary outcomes including hospital mortality, ICU-free days, and hypoglycemic events. Results: Among 622 patients, the high GCI group exhibited significantly higher one-year all-cause mortality (37% vs. 19% and 18% in medium and low groups, respectively; p < 0.001) and fewer ICU-free days within 28 days (p = 0.007). Conversely, the low GCI group was associated with an increased risk of hypoglycemia (44% vs. 29% and 15% in medium and high groups, respectively; p < 0.001). After adjusting for confounders, the high GCI group demonstrated a significantly elevated risk of one-year mortality compared to the medium and low group. Time-dependent ROC analysis confirmed GCI's prognostic value, with AUC values ranging from 0.671 at one month to 0.634 at 12 months. Conclusions: Higher GCI values are associated with increased one-year mortality and fewer ICU-free days in AMI patients with diabetes, whereas lower GCI values correlate with a higher risk of hypoglycemia. The GCI shows potential as a personalized prognostic tool, pending further validation

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Section: Discussionmentioning

confidence: 99%

Glycemic Comparison Index (GCI): A Retrospective Analysis of its Prognostic Value in ICU Patients with AMI and Diabetes

She,

Wang,

et al. 2024

Preprint

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“…Firstly, diabetic patients are more susceptible to atherosclerosis, leading to diffuse and multivessel damage to the coronary arteries [22]. Secondly, the deleterious effects of cardiac glucotoxicity are caused by supraphysiological levels of glucose damage to cardiomyocytes, cardiac endothelial cells and the coagulation system, where hyperglycaemia reduces endothelium-dependent vasodilatation, impairs endothelial repair, and is thought to have a direct effect on remodelling of infarcted cardiac tissue [23]. A related study by Gil-Perez stated that diabetes is an independent risk factor for MACE [24], which is consistent with our findings.…”

Section: Discussionmentioning

confidence: 99%

Construction and validation of a predictive model for major adverse cardiovascular events in the long term after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

Yang,

Yin,

Zhang

et al. 2024

Coronary Artery Disease

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Purpose Construction of a prediction model to predict the risk of major adverse cardiovascular events (MACE) in the long term after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Method Retrospective analysis of STEMI patients treated with PCI from April 2018 to April 2021 in Fuyang People’s Hospital. Lasso regression was used to screen the risk factors for the first occurrence of MACE in patients, and multifactorial logistic regression analysis was used to construct a prediction model. The efficacy was evaluated by area under the ROC curve (AUC), Hosmer–Lemeshow deviance test, calibration curve, clinical decision curve (DCA) and clinical impact curve (CIC). Results Logistic regression results showed that hypertension, diabetes mellitus, left main plus three branches lesion, estimated glomerular filtration rate and medication adherence were influential factors in the occurrence of distant MACE after PCI in STEMI patients (P < 0.05). The AUC was 0.849 in the modeling group and 0.724 in the validation group; the calibration curve had a good fit to the standard curve, and the result of the Hosmer–Lemeshow test of deviance was x2 = 7.742 (P = 0. 459); the DCA and the CIC indicated that the predictive model could provide a better net clinical benefit for STEMI patients. Conclusion A prediction model constructed from a total of five predictor variables, namely hypertension, diabetes, left main + three branches lesions, eGFR and medication adherence, can be used to assess the long-term prognosis after PCI in STEMI patients and help in early risk stratification of patients.

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“…Stress-induced hyperglycemia is associated with risk of death or poor outcomes after acute myocardial infarction (AMI) [ 143 ] and intensive control of hyperglycemia in people with diabetes is associated with reduced mortality in the 12 months following an AMI [ 144 ]. This effect is most pronounced in people with T2DM naïve to insulin prior to admission to hospital [ 144 ], and can persist up to 8 years following intervention [ 145 ].…”

Section: Controlling Hyperglycemia In Acute Care Settingsmentioning

confidence: 99%

Expanding the Role of Continuous Glucose Monitoring in Modern Diabetes Care Beyond Type 1 Disease

et al. 2023

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Application of continuous glucose monitoring (CGM) has moved diabetes care from a reactive to a proactive process, in which a person with diabetes can prevent episodes of hypoglycemia or hyperglycemia, rather than taking action only once low and high glucose are detected. Consequently, CGM devices are now seen as the standard of care for people with type 1 diabetes mellitus (T1DM). Evidence now supports the use of CGM in people with type 2 diabetes mellitus (T2DM) on any treatment regimen, not just for those on insulin therapy. Expanding the application of CGM to include all people with T1DM or T2DM can support effective intensification of therapies to reduce glucose exposure and lower the risk of complications and hospital admissions, which are associated with high healthcare costs. All of this can be achieved while minimizing the risk of hypoglycemia and improving quality of life for people with diabetes. Wider application of CGM can also bring considerable benefits for women with diabetes during pregnancy and their children, as well as providing support for acute care of hospital inpatients who experience the adverse effects of hyperglycemia following admission and surgical procedures, as a consequence of treatment-related insulin resistance or reduced insulin secretion. By tailoring the application of CGM for daily or intermittent use, depending on the patient profile and their needs, one can ensure the cost-effectiveness of CGM in each setting. In this article we discuss the evidence-based benefits of expanding the use of CGM technology to include all people with diabetes, along with a diverse population of people with non-diabetic glycemic dysregulation. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-023-01431-3.

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Editorial: Hyperglycemia and Coronary Artery Diseases: Physio-Pathological Findings and Therapeutic Implications

Cited by 6 publications

References 28 publications

Glycemic Comparison Index (GCI): A Retrospective Analysis of its Prognostic Value in ICU Patients with AMI and Diabetes

Glycemic Comparison Index (GCI): A Retrospective Analysis of its Prognostic Value in ICU Patients with AMI and Diabetes

Construction and validation of a predictive model for major adverse cardiovascular events in the long term after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

Expanding the Role of Continuous Glucose Monitoring in Modern Diabetes Care Beyond Type 1 Disease

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