Predictive Value of the Acute-to-Chronic Glycemic Ratio for In-Hospital Outcomes in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Abstract

This study investigated whether a novel index of stress hyperglycemia might have a better prognostic value compared to admission glycemia alone in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). The acute-to-chronic glycemic ratio was expressed as admission blood glucose (ABG) devided by the estimated average glucose (eAG), and eAG was derived from the glycated hemoglobin (HbA1c). A total of 1300 consecutive patients with STEMI treated with PCI were included. Baseline data and outcomes were analyzed. The study end point was a composite of in-hospital all-cause death, cardiogenic shock, and acute pulmonary edema. Accuracy was defined with area under the curve (AUC) by a receiver–operating characteristic (ROC) curve analysis. After multivariate adjustment, both ABG/eAG and ABG were closely associated with an increased risk of the composite end point in nondiabetic patients. However, only ABG/eAG (odds ratio = 2.45, 95% confidence interval: 1.24-4.82, P = .010), instead of ABG, was associated with the outcomes in diabetic patients. Compared to ABG, ABG/eAG had an equivalent predictive value in nondiabetic patients but a superior discriminatory ability in diabetic patients (AUC improved from 0.52-0.63, P < .001). Taken together, ABG/eAG provides more significant in-hospital prognostic information than ABG in diabetic patients with STEMI after PCI.

Augmented glycaemic gap is a marker for an increased risk of post-infarct left ventricular systolic dysfunction

“…Instead of ABG, both glycaemic gap and SHR were associated with major adverse cardiac events (MACEs) and could provide moderate predictive value for the occurrence of MACEs in AMI patients with DM [15,22,34]. Liao et al further demonstrated glycaemic gap rather than ABG was linked to all-cause mortality in acute heart failure (AHF) patients with DM [35].…”

“…High-performance liquid chromatography analysers were used to examine glycated haemoglobin (HbA 1 c) levels. Then, we obtained the estimated average glucose (eAG) level over the previous 3 months through the following equation: eAG = 28.7 * HbA1c − 46.7 [14,15,18], and glycaemic gap was calculated as ABG minus eAG. SHR, another index of relative hyperglycaemia, was defined as ABG/ eAG.…”

“…Admission blood glucose (ABG) has been mainly regarded as an index of SIH in previous studies [13]. The ABG level is impacted by both acute physiological stress and chronic baseline glycaemic levels, so it does not reflect the extent of SIH accurately in an acutely ill state [14,15]. Furthermore, reports by Esposito et al and Monnier et al suggested that acute glucose fluctuations induced by SIH could be more harmful than sustained hyperglycaemia [16,17].…”

“…To assess the effect of SIH more accurately, glycaemic gap and stress hyperglycaemia ratio (SHR), which eliminates the interference of chronic baseline glycaemic levels, were proposed as a novel index of SIH [18][19][20]. Considerable evidence have confirmed both glycaemic gap and SHR were strongly correlated with adverse cardiovascular outcome in AMI patients [15,21,22], but we knew little about the association between these indexes and post-infarct LVSD. Therefore, we mainly investigated the correlation between glycaemic gap and post-infarct LVSD in the present study.…”

The association of acute­-to­-chronic glycemic ratio with no-reflow in patients with ST­-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

“…This index is calculated as ABG divided by the estimated average glucose (eAG). In recent studies, it has been found that the use of ABG/eAG ratio has an adequate performance compared to the use of absolute hyperglycemia for predicting poor cardiovascular outcomes, such as cardiogenic shock and acute pulmonary edema, both in non-diabetic and diabetic patients with STEMI [10,11].…”