Hyperglycaemia, adverse outcomes and impact of intravenous insulin therapy in patients presenting with acute ST‐elevation myocardial infarction in a socioeconomically disadvantaged urban setting: The Montefiore STEMI Registry

Shitole, Sanyog G.; Srinivas, Vankeepuram S.; Berkowitz, Julia; Shah, Tina; Park, Michael J.; Herzig, Samuel; Christian, Anne; Patel, Neeral; Xue, Xiaonan; Scheuer, James; Kizer, Jorge R.

doi:10.1002/edm2.89

Cited by 7 publications

(8 citation statements)

References 38 publications

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“…Direct comparison of SHR from other studies reveals remarkably similar degrees of SIH. STEMI has been associated with SHR of 1.22, 21 and 1.21 (implied value from study data 20 ), consistent with the SHR of 1.22 in this study. Gao et al observed SHR of 1.19 and 1.29 for STEMI in those without and with diabetes, almost identical to the 1.18 and 1.26 in this study 21 .…”

Section: Discussionsupporting

confidence: 89%

“…STEMI has been associated with SHR of 1.22, 21 and 1.21 (implied value from study data 20 ), consistent with the SHR of 1.22 in this study. Gao et al observed SHR of 1.19 and 1.29 for STEMI in those without and with diabetes, almost identical to the 1.18 and 1.26 in this study 21 . Mean SHR 1.00 was observed for ischaemic stroke, similar to the SHR of 1.07 in this study 14 .…”

Section: Discussionsupporting

confidence: 89%

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Quantification of stress‐induced hyperglycaemia associated with key diagnostic categories using the stress hyperglycaemia ratio

2022

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Aim: Stress-induced hyperglycaemia (SIH) is the acute increase from preadmission glycaemia and is associated with poor outcomes. Early recognition of SIH and subsequent blood glucose (BG) management improves outcomes, but the degree of SIH provoked by distinct diagnostic categories remains unknown. Quantification of SIH is now possible using the stress hyperglycaemia ratio (SHR), which measures the proportional change from preadmission glycaemia, based on haemoglobin A 1c (HbA 1c ). Methods:We identified eligible patients for eight medical (n = 892) and eight surgical (n = 347) categories. Maximum BG from the first 24 h of admission for medical, or postoperatively for surgical patients was used to calculate SHR.Results: Analysis of variance indicated differing SHR and BG within both the medical (p < 0.0001 for both) and surgical cohort (p < 0.0001 for both). Diagnostic categories were associated with signature levels of SHR that varied between groups. Medically, SHR was greatest for ST-elevation myocardial infarction (1.22 ± 0.33) and sepsis (1.37 ± 0.43). Surgically, SHR was greatest for colectomy (1.62 ± 0.48) and cardiac surgeries (coronary artery graft 1.56 ± 0.43, aortic valve replacement 1.71 ± 0.33, and mitral valve replacement 1.75 ± 0.34). SHR values remained independent of HbA 1c , with no difference for those with HbA 1c above or below 6.5% (p > 0.11 for each). BG however was highly dependent on HbA 1c , invariably elevated in those with HbA 1c ≥ 6.5% (p < 0.001 for each), and unreliably reflected SIH. Conclusion:The acute stress response associated with various medical and surgical categories is associated with signature levels of SIH. Those with higher expected SHR are more likely to benefit from early SIH management, especially major surgery, which induced SIH typically 40% greater than medical cohorts. SHR equally recognised the acute change in BG from baseline across the full HbA 1c spectrum while BG did not and poorly reflected SIH. K E Y W O R D Sdiabetes, HbA 1c , stress hyperglycaemia ratio, stress-induced hyperglycaemia How to cite this article: Roberts GW, Larwood C, Krinsley JS. Quantification of stress-induced hyperglycaemia associated with key diagnostic categories using the stress hyperglycaemia ratio.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 89%

Quantification of stress‐induced hyperglycaemia associated with key diagnostic categories using the stress hyperglycaemia ratio

2022

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“…Hypertension was defined by history or use of antihypertensive medications. Diabetes was defined by history or use of antihyperglycemic agents 15 . Hyperlipidemia was defined by history or use of an antihyperlipidemic drug.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of ST‐elevation myocardial infarction by age and sex in a low‐income urban community: The Montefiore STEMI Registry

Bortnick

Shahid

Shitole

et al. 2020

Clinical Cardiology

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Objectives: To compare outcomes by age and sex in race/ethnic minorities presenting with ST-elevation myocardial infarction (STEMI), as studies are limited. Methods: We studied sociodemographics, management, and outcomes in 1208 STEMI patients evaluated for primary percutaneous coronary intervention between 2008 and 2014 at Montefiore Health System (Bronx, NY). A majority of patients self-identified as nonwhite, and nearly two-thirds were young (<45 years) or middle-aged (45-64 years). Results: Risk factors varied significantly across age groups; with more women and non-Hispanic whites, hypertension, diabetes, dyslipidemia, prior cardiovascular disease, non-sinus rhythm, and collagen vascular disease in the older age group (≥65 years); and higher body mass index, smoking, cocaine use, human immunodeficiency virus (HIV) infection and family history of heart disease in the young. Younger women had lower summary socioeconomic scores than younger men. Middle-aged women had more obesity and dysmetabolism, while men had more heavy alcohol use. There was greater disease severity with increasing age; with higher cardiac biomarkers, 3-vessel disease, cardiogenic shock, and coronary artery bypass grafting. Older patients had higher rates of death and death or readmission over 4.3 (interquartile range 2.4, 6.0) years of follow-up. Middle-aged women had higher rates of death or any readmission than men, but these differences were not significant after adjustment.

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“…Details of the Montefiore STEMI Registry have been described before (15,16). Briefly, the registry included all STEMI patients considered for acute revascularization at Montefiore Health System (MHS) from May 2008 to December 2014 and providing informed consent.…”

Section: Methodsmentioning

confidence: 99%

“…We turned to a well-characterized cohort with ST-segment elevation myocardial infarction (STEMI) receiving acute care at an inner-city health system to evaluate the impact of HIV and HCV on long-term outcomes in this predominantly black and Hispanic population. We leveraged data from the Montefiore STEMI Registry (15,16) over 7 years to examine the baseline differences at index STEMI hospitalization between groups based on HIV and HCV status and to evaluate differences in outcomes post-STEMI.…”

Section: Introductionmentioning

confidence: 99%

Association of human immunodeficiency virus and hepatitis C virus infection with long-term outcomes post-ST segment elevation myocardial infarction in a disadvantaged urban community

et al. 2020

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Background: HIV and HCV have been linked to an increased risk of cardiovascular disease (CVD). Their impact on long-term outcomes following ST-segment myocardial infarction (STEMI) has not been previously studied. Methods:We leveraged data from a STEMI registry (n=1208) at an inner-city health system to assess the influence of HIV and HCV on post-STEMI outcomes. Cox regression was used to compare HIV-monoinfected (n=22), HCV-monoinfected (n=26) and HIV-HCV-coinfected patients (n=8) with the neither-infected group (n=1152) with regard to death, death or any readmission, and death or CVD readmission. Results:The cohort was majority black or Hispanic. Median follow-up was 4.3 years. Compared to the neither-infected group, the HIV-monoinfected group showed near-significantly higher risks of death or any readmission (HR=1.62, 95% CI=0.96, 2.74) and death or CVD readmission (HR=1.82, 95% CI=0.98, 3.39) after full adjustment. On similar comparison, the HCVmonoinfected group exhibited significantly higher risks of death (HR=2.09, 95% CI=1.05, 4.15) and death or any readmission (HR=1.68, 95% CI=1.07, 2.65), whereas the HIV-HCV-coinfected group showed higher risk of death (HR=6.51, 95% CI=2.28, 18.61). Conclusions:In this cohort composed mostly of race-ethnic minorities, HIV monoinfection tended to be associated with 1.6-to-1.8-fold higher death or readmission for any cause or CVD over long-term follow-up compared to neither infection, whereas HCV monoinfection was associated with 1.7-to-2.1-fold higher death and death or any readmission, and HIV-HCV coinfection with 6.5-fold higher death. These associations require further study in larger populations, but highlight the importance of identifying and treating HIV and HCV in patients presenting with STEMI.

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Hyperglycaemia, adverse outcomes and impact of intravenous insulin therapy in patients presenting with acute ST‐elevation myocardial infarction in a socioeconomically disadvantaged urban setting: The Montefiore STEMI Registry

Cited by 7 publications

References 38 publications

Quantification of stress‐induced hyperglycaemia associated with key diagnostic categories using the stress hyperglycaemia ratio

Quantification of stress‐induced hyperglycaemia associated with key diagnostic categories using the stress hyperglycaemia ratio

Outcomes of ST‐elevation myocardial infarction by age and sex in a low‐income urban community: The Montefiore STEMI Registry

Association of human immunodeficiency virus and hepatitis C virus infection with long-term outcomes post-ST segment elevation myocardial infarction in a disadvantaged urban community

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