Impact of admission hyperglycemia on short and long-term prognosis in acute myocardial infarction: MINOCA versus MIOCA

Abstract

Background The prognostic role of hyperglycemia in patients with myocardial infarction and obstructive coronary arteries (MIOCA) is acknowledged, while data on non-obstructive coronary arteries (MINOCA) are still lacking. Recently, we demonstrated that admission stress-hyperglycemia (aHGL) was associated with a larger infarct size and inflammatory response in MIOCA, while no differences were observed in MINOCA. We aim to investigate the impact of aHGL on short and long-term outcomes in MIOCA and MINOCA patients. Methods Multicenter, population-based, cohort study of the prospective registry, designed to evaluate the prognostic information of patients admitted with acute myocardial infarction to S. Orsola-Malpighi and Maggiore Hospitals of Bologna metropolitan area. Among 2704 patients enrolled from 2016 to 2020, 2431 patients were classified according to the presence of aHGL (defined as admission glucose level ≥ 140 mg/dL) and AMI phenotype (MIOCA/MINOCA): no-aHGL (n = 1321), aHGL (n = 877) in MIOCA and no-aHGL (n = 195), aHGL (n = 38) in MINOCA. Short-term outcomes included in-hospital death and arrhythmias. Long-term outcomes were all-cause and cardiovascular mortality. Results aHGL was associated with a higher in-hospital arrhythmic burden in MINOCA and MIOCA, with increased in-hospital mortality only in MIOCA. After adjusting for age, gender, hypertension, Killip class and AMI phenotypes, aHGL predicted higher in-hospital mortality in non-diabetic (HR = 4.2; 95% CI 1.9–9.5, p = 0.001) and diabetic patients (HR = 3.5, 95% CI 1.5–8.2, p = 0.003). During long-term follow-up, aHGL was associated with 2-fold increased mortality in MIOCA and a 4-fold increase in MINOCA (p = 0.032 and p = 0.016). Kaplan Meier 3-year survival of non-hyperglycemic patients was greater than in aHGL patients for both groups. No differences in survival were found between hyperglycemic MIOCA and MINOCA patients. After adjusting for age, gender, hypertension, smoking, LVEF, STEMI/NSTEMI and AMI phenotypes (MIOCA/MINOCA), aHGL predicted higher long-term mortality. Conclusions aHGL was identified as a strong predictor of adverse short- and long-term outcomes in both MIOCA and MINOCA, regardless of diabetes. aHGL should be considered a high-risk prognostic marker in all AMI patients, independently of the underlying coronary anatomy. Trial registration data were part of the ongoing observational study AMIPE: Acute Myocardial Infarction, Prognostic and Therapeutic Evaluation. ClinicalTrials.gov Identifier: NCT03883711.

Predictive value of the stress hyperglycemia ratio in patients with acute ST-segment elevation myocardial infarction: insights from a multi-center observational study

“…Several studies have reported that stress hyperglycemia is independently related to increased mortality and larger infarct size in patients with MI [ 3 , 18 , 19 ]. Paolisso et al reported that admission hyperglycemia is also an effective predictor of short and long-term prognosis in patients with AMI, including those with MINOCA, indicating that hyperglycemia may play a direct role in microvascular dysfunction [ 5 ]. While these data suggest that ABG can be considered a predictor of AMI prognosis, the predictive effectiveness of ABG depends on its definition and the threshold used to characterize stress hyperglycemia.…”

“…While increases in the use of reperfusion therapy, percutaneous coronary intervention (PCI), and secondary prevention therapy have decreased the mortality of ST-segment elevation myocardial infarction (STEMI), the incidence of in-hospital mortality remains high at 4–12% [ 1 , 2 ]. Stress hyperglycemia—defined as a transient increase in blood glucose related to the stress of illness, is a strong predictive factor for adverse outcomes in patients with acute myocardial infarction (AMI) [ 3 , 4 ], including those with non-obstructive coronary arteries (MINOCA) [ 5 ]. To explain this phenomenon, researchers have speculated that stress hyperglycemia caused by sympathetic system activation, leads to oxidative stress and endothelial dysfunctions [ 6 ].…”

Comparison of clinical profiles and care for patients with incident versus recurrent acute coronary syndromes in France: Data from the MONICA registries

“…In an Italian registry with around 2500 patients, it was shown that hyperglycemic patients with obstructive acute MI had higher inflammatory markers and larger infarct sizes compared to normoglycemic ones [ 21 ]. In addition, admission stress-hyperglycemia predicted higher in-hospital and long-term (3 year) mortality, regardless of diabetes, in both patients with obstructive or non-obstructive coronary arteries [ 22 ].…”

Association of diabetes mellitus with clinical outcomes in patients with different coronary artery stenosis

“…Hence, recent guidelines and expert consensus have been characterized by further emphasizing the assessment risk factors combined with obvious cardiovascular pathological lesions in patients with diabetes [ 6 , 17 ]. The potential mechanism of diabetes as a risk factor of cardiovascular diseases might because of hyperglycemia influences the pathology of coronary microvascular, inflammation and sympathetic nervous system activity, vasospastic and structural remodeling of circulation, resulting in an increased cardiovascular risk [ 17 , 30 ]. Although our study did not provide the detailed mechanism exploration, the present study might support the notion that diabetes could impose a bad impact on the adverse outcome in patients with CAD, even in those with intermediate coronary stenosis.…”