Incidence, predictors and outcomes of stress hyperglycemia in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention

Abstract

Background: Stress hyperglycemia is a common finding during ST elevation myocardial infarction in diabetic patients and is associated with a worse outcome. However, there are limited data about stress hyperglycemia in non-diabetic patients and its outcome especially in patients undergoing primary percutaneous coronary intervention. Methods: The study was conducted on 660 patients with ST elevation myocardial infarction who were managed with primary percutaneous coronary intervention. Patients were classified into two groups according to the presence of stress hyperglycemia: group I (patients with stress hyperglycemia) and group II (patients without stress hyperglycemia). Patients were analysed for clinical outcome including mortality and the occurrence of major adverse cardiac events. Results: Incidence of stress hyperglycemia was 16.8%, multivariate regression analysis identified the independent predictors of stress hyperglycemia, that were family history of diabetes mellitus odds ratio 1.697 (95% confidence interval: 1.077–2.674, p = 0.023), body mass index >24 kg/m2 odds ratio 1.906 (95% confidence interval: 1.244–2.922, p = 0.003) and cardiogenic shock on admission odds ratio 2.517 (95% confidence interval: 1.162–5.451, p = 0.019). Mortality, cardiogenic shock, contrast induced nephropathy and no reflow phenomenon were significantly higher in stress hyperglycemia group with p value = 0.027, 0.001, 0.020 and 0.037, respectively. Conclusion: Stress hyperglycemia in non-diabetic patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention is associated with increased incidence of no reflow phenomenon, contrast induced nephropathy, cardiogenic shock and higher mortality.

Stress Hyperglycemia Is Independently Associated with Persistent Organ Failure in Acute Pancreatitis

“…Actually, stress hyperglycemia was usually found in patients without known pre-existing DM, and there is no agreed definition of stress hyperglycemia in different acute and critical illnesses [8,37]. Dungan et al defined stress hyperglycemia as fasting plasma glucose levels ≥ 126 mg/dl for non-diabetic patients [8], and the definition varies in different studies, such as myocardial infarction (≥ 110, ≥ 120, ≥ 140, ≥ 144, ≥ 180, or ≥ 200 mg/dl) [9,38], surgery (≥ 140 or ≥ 180 mg/ dl) [11,[39][40][41] and critical illness (≥ 126 or ≥ 200 mg/dl) [42,43]. In our study, we defined stress hyperglycemia for non-diabetic patients as ≥ 126, ≥ 140, ≥ 180, and ≥ 200 mg/ dl, and selected a cut-off BG level of ≥ 180 mg/dl to provide a better definition according to multivariate logistic regression and ROC curves.…”

Unique role of admission hyperglycemia on myocardial infarction size and area at risk following an acute ST-elevation myocardial infarction

“…Egypt has nearly 100 million people who have special demographic and social characteristics which increase the possibility of the stress-induced conditions and its health-associated problems; some of these characteristics may be shared with other developing nations. Previous Egyptian studies confirmed that elevated admission glucose level is a strong predictor of short-term adverse outcomes in patients with AMI but no previous studies in our country regarding the impact of AH on AAR, FIS, or SI which is the major concept of our research [10,11]. An Indian study had addressed the association of AHG and increased myocardial damage evidenced by cardiac biomarkers and echocardiographic derived data but without using CMR modality.…”

Impact of stress hyperglycemia on myocardial salvage in patients with ST-Elevation myocardial infarction: Cardiac magnetic resonance study

“…Previous studies confirmed that elevated admission glucose level is a strong predictor of short-term adverse outcomes in patients with AMI but, no previous studies in our country regarding the impact of AH on AAR, FIS, or SI which is the major concept of our research. 11 …”