Hypoglycemia is associated with a higher risk of mortality and arrhythmias in ST-elevation myocardial infarction, irrespective of diabetes

Humos, Basel; Mahfoud, Ziyad; Dargham, Soha R.; Suwaidi, Jassim Al; Jneid, Hani; Khalil, Charbel Abi

doi:10.3389/fcvm.2022.940035

Cited by 14 publications

(14 citation statements)

References 48 publications

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“…Furthermore, it is necessary to reasonably control the patients' blood glucose levels after the operation. Low blood glucose levels were found to be correlated with poor cardiovascular prognosis of CAD patients [21,22] . Following cardiac surgery, appropriate blood glucose level control (7.8-10.0 mmol/L) could help improve clinical outcomes [23,24] .…”

Section: Incomplete Vascularization and Graft Lesions Are Common Caus...mentioning

confidence: 94%

The Efficacy of Minimally Invasive Coronary Artery Bypass Grafting (MICS CABG) for Patients with Coronary Artery Diseases and Diabetes: A Single Center Retrospective Study

ZHAO,

CHI,

LIANG

et al. 2023

Preprint

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Background conventional coronary artery bypass grafting (CCABG) tends to cause severe complications in patients with comorbid Coronary Artery Diseases (CAD) and diabetes. On the other hand, the Minimally Invasive Cardiac Surgery Coronary Artery Bypass Grafting (MICS CABG) via transthoracic incision is associated with rapid recovery and reduced complications. Adding to the limited literature, this study compares CCABG and MICS CABG in terms of efficacy and safety.Methods Herein, 104 CCABG and MICS CABG cases (52 cases each) were included. The patients were recruited from the Minimally Invasive Cardiac Surgery Center, Anzhen Hospital, between January 2017 and December 2021 and were selected based on the Propensity Score Matching (PSM) model. The key outcomes included All-cause Death, Myocardial Infarction (MI), Cerebrovascular Events, revascularization, Adverse Wound Healing Events and one-year patency of the graft by coronary CTA.Results Compared to CCABG, MICS CABG had longer surgical durations[4.25 (1.50) h vs.4.00 (1.13) h, p = 0.028], but showed a reduced intraoperative blood loss [600.00 (400.00) mL vs.700.00 (300.00) mL, p = 0.032] and a lower secondary incision debridement and suturing rate (5.8% vs.19.2%, p = 0.038). No statistically significant differences were found between the two groups in the cumulative Major Adverse Cardiovascular and Cerebrovascular Events (MACCEs) incidence (7.7% vs. 5.9%), all-cause mortality (0 vs. 0), MI incidence (1.9% vs. 2.0%), cerebral apoplexy incidence (5.8% vs. 3.9%), and repeated revascularization incidence (0 vs. 0) (p > 0.05). Additionally, coronary CTA results revealed that the two groups’ one-year graft patency (94.2% vs. 90.2%, p = 0.761) showed no statistically significant difference.Conclusion In patients with comorbid CAD and diabetes, MICS CABG and CCABG had comparable revascularization performances. Moreover, MICS CABG can effectively reduce, if not prevent, poor clinical outcomes/complications, including incision healing, sternal infection, prolonged length of stay, and slow recovery of body function in diabetes patients.

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Section: Incomplete Vascularization and Graft Lesions Are Common Caus...mentioning

confidence: 94%

The Efficacy of Minimally Invasive Coronary Artery Bypass Grafting (MICS CABG) for Patients with Coronary Artery Diseases and Diabetes: A Single Center Retrospective Study

ZHAO,

CHI,

LIANG

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…Moreover, hypoglycemia is independently associated with cardio and cerebrovascular events independent of insulin treatment. [105][106][107][108]…”

Section: Down-regulated Proteins -Mild Hypoglycemiamentioning

confidence: 99%

Acute severe hypoglycemia alters mouse brain microvascular proteome

Sakamuri,

Sure,

Oruganti

et al. 2023

J Cereb Blood Flow Metab

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Hypoglycemia increases the risk related to stroke and neurodegenerative diseases, however, the underlying mechanisms are unclear. For the first time, we studied the effect of a single episode (acute) of severe (ASH) and mild (AMH) hypoglycemia on mouse brain microvascular proteome. After four-hour fasting, insulin was administered (i.p) to lower mean blood glucose in mice and induce ∼30 minutes of ASH (∼30 mg/dL) or AMH (∼75 mg/dL), whereas a similar volume of saline was given to control mice (∼130 mg/dL). Blood glucose was allowed to recover over 60 minutes either spontaneously or by 20% dextrose administration (i.p). Twenty-four hours later, the brain microvessels (BMVs) were isolated, and tandem mass tag (TMT)–based quantitative proteomics was performed using liquid chromatography-mass spectrometry (LC/MS). When compared to control, ASH significantly downregulated 13 proteins (p ≤ 0.05) whereas 23 proteins showed a strong trend toward decrease (p ≤ 0.10). When compared to AMH, ASH significantly induced the expression of 35 proteins with 13 proteins showing an increasing trend. AMH downregulated only 3 proteins. ASH-induced downregulated proteins are involved in actin cytoskeleton maintenance needed for cell shape and migration which are critical for blood-brain barrier maintenance and angiogenesis. In contrast, ASH-induced upregulated proteins are RNA-binding proteins involved in RNA splicing, transport, and stability. Thus, ASH alters BMV proteomics to impair cytoskeletal integrity and RNA processing which are critical for cerebrovascular function.

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“…As hypoglycemia is de ned as blood sugar of 3.9 mmol/L or less and previous studies have found that hypoglycemia is associated with a higher risk of mortality in non-diabetic STEMI patients [10] . Thus, the relationship between ABG and MACE was analyzed again after excluding patients with ABG less than 4 mmol/L (n=34).…”

Section: Sensitivity Analysis--after Excluding Patients With Abg Less...mentioning

confidence: 99%

The Relationship between Admission Blood Glucose Levels and Major Adverse Cardiovascular Events during Hospitalization in Non-Diabetic ST-Segment Elevation Myocardial Infarction (Killip I) Patients Undergoing Primary Percutaneous Coronary Intervention

Zhang,

Zeng,

et al. 2023

Preprint

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Background: Our objective was to investigate the correlation between admission blood glucose (ABG) levels and the occurrence of in-hospital major adverse cardiovascular events (MACE) in non-diabetic patients (Killip class I), with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (pPCI). Methods: This retrospective observational study, registered in Clinical Trials (NCT04996901), included a total of 5586 patients with STEMI between January 2015 to August 2021. The occurrence of MACE was determined through the presence of acute heart failure and in-hospital death. Results： A total of 2890 patients were ultimately identified for inclusion in the study. These patients were categorized into three groups based on their ABG levels: Q1 (2.5-5.72 mmol/L), Q2 (5.73-7.0 mmol/L), and Q3 (7.01-11.0 mmol/L). Multivariate analysis, adjusting for age, gender, diastolic blood pressure (DBP), heart rate (HR), smoking, hypertension, and other factors, revealed that the odds ratio (OR) for MACE in Q2 and Q3 was 1.43-1.62 times higher compared to Q1 in calibration Models II to IV. Subgroup analysis indicated that the OR for Q2 was 3.52-fold higher in females and 1.54-fold higher in individuals aged 60 years or older. Sensitivity analysis, excluding patients with ABG levels below 4 mmol/L, still demonstrated a significant association between elevated ABG and increased risk of MACE. The area under the receiver operating characteristic (ROC) curve for ABG in predicting MACE occurrence after pPCI was 0.668, and the C-index in the calibration curve was 0.666. Cubic spline analysis further confirmed a significant decrease in MACE risk with ABG reduction below 6.3 mmol/L. CONCLUSIONS: In non-diabetic STEMI patients treated with pPCI, elevated ABG levels are linked to a higher risk of in-hospital MACE. Notably, this association is more pronounced in female patients and older individuals.

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Hypoglycemia is associated with a higher risk of mortality and arrhythmias in ST-elevation myocardial infarction, irrespective of diabetes

Cited by 14 publications

References 48 publications

The Efficacy of Minimally Invasive Coronary Artery Bypass Grafting (MICS CABG) for Patients with Coronary Artery Diseases and Diabetes: A Single Center Retrospective Study

The Efficacy of Minimally Invasive Coronary Artery Bypass Grafting (MICS CABG) for Patients with Coronary Artery Diseases and Diabetes: A Single Center Retrospective Study

Acute severe hypoglycemia alters mouse brain microvascular proteome

The Relationship between Admission Blood Glucose Levels and Major Adverse Cardiovascular Events during Hospitalization in Non-Diabetic ST-Segment Elevation Myocardial Infarction (Killip I) Patients Undergoing Primary Percutaneous Coronary Intervention

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