Effect of Admission Hyperglycemia on Short-Term Prognosis of Patients with Non-ST Elevation Acute Coronary Syndrome without Diabetes Mellitus

Abstract

Objective. To evaluate the effect of admission hyperglycemia on the short-term prognosis of patients with non-ST elevation acute coronary syndrome (NSTE-ACS) without diabetes mellitus. Methods. The clinical data of 498 patients with NSTE-ACS admitted to the Department of Cardiology of the First Affiliated Hospital of Henan University of Science and Technology between March 2018 and November 2020 were analyzed. Based on the blood glucose (BG) level at admission, patients were divided into three groups: A ( BG < 7.8 mmol/L), B ( 7.8 mmol / L ≤ BG < 11.1 mmol / L ), and C ( BG ≥ 11.1 mmol/L). The clinical data of the three groups were compared. Results. There was no significant difference between the three groups in terms of age, sex, hypertension, hyperlipidemia, smoking, and history of myocardial infarction ( p > 0.05 ). However, there were significant differences in the incidences of multivessel disease, renal insufficiency, pump failure, and emergency percutaneous coronary intervention, and levels of high-sensitivity C-reactive protein, cardiac troponin T, and creatine kinase isoenzyme MB among the three groups ( p < 0.05 for all). The incidences of severe pump failure, malignant arrhythmias, and death were significantly higher in groups B and C compared to group A ( p < 0.05 ). Additionally, the incidences of severe pump failure, malignant arrhythmias, and death were significantly higher in group C compared to group B ( p < 0.05 ). Multivariate logistic regression analysis showed that hyperglycemia, renal insufficiency, Killip grade III/IV, and age were risk factors of in-hospital death. Conclusion. Hyperglycemia at admission is a risk factor for adverse in-hospital clinical outcomes in patients with NSTE-ACS.

Association of admission hyperglycemia and all-cause mortality in acute myocardial infarction with percutaneous coronary intervention: A dose–response meta-analysis

“…Ten studies ( 8 , 27 – 35 ) reported short-term all-cause mortality, four studies ( 36 – 39 ) reported long-term all-cause mortality, and nine studies ( 6 , 7 , 40 – 46 ) reported both short- and long-term all-cause mortality, which were included in the primary meta-analysis. Eight studies ( 7 , 29 – 31 , 34 , 37 , 43 , 45 ) were also used for secondary outcomes.…”

“…Severely elevated glucose levels were significantly associated with MACEs compared with mildly to moderately elevated glucose levels. Higher blood glucose levels at admission were associated with higher incidence of multivessel disease ( 7 ) and acute kidney injury ( 30 , 34 ), larger infarct size ( 30 ), lower initial success rate of primary PCI ( 7 ), and worse post-PCI TIMI flow grades ( 31 )—degree of flow filling the distal coronary bed. Most events in MACEs were driven by in-hospital mortality ( 30 ) and heart failure ( 34 ).…”

“…Higher blood glucose levels at admission were associated with higher incidence of multivessel disease ( 7 ) and acute kidney injury ( 30 , 34 ), larger infarct size ( 30 ), lower initial success rate of primary PCI ( 7 ), and worse post-PCI TIMI flow grades ( 31 )—degree of flow filling the distal coronary bed. Most events in MACEs were driven by in-hospital mortality ( 30 ) and heart failure ( 34 ). We also found that this association between AH and MACEs became stronger when patients received PCI within 24 h rather than primary PCI (RR 2.78 vs. 2.07), and that AH had long-term effects associated with MACEs albeit less than short-term effects (1.95 vs. 2.34).…”

Occurrence of Severe Arrhythmias in Patients with Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS): A Retrospective Study

“…The study of Sauer et al [22] showed an increased risk of ventricular rhythm disorders with morphine administration in patients with STEMI. Furthermore, the studies of Tran et al [23] and Liu et al [24] suggested an increased risk of rhythm disorders with hyperglycemia in patients with NSTE-ACS.…”