Prognostic value of early in-hospital glycemic excursion in elderly patients with acute myocardial infarction

Abstract

BackgroundAcute phase hyperglycemia has been associated with increased mortality in patients with acute myocardial infarction (AMI). However, the predictive value of glycemic excursion for adverse outcome in elderly AMI patients is not clear. The aim of this study is to investigate the prognostic value of early in-hospital glycemic excursion and hemoglobin A1c (HbA1c) for one-year major adverse cardiac event (MACE) in elderly patients with AMI.MethodsWe studied 186 elderly AMI patients, whose clinical data were collected and the Global Registry of Acute Coronary Events (GRACE) risk score were calculated on admission. The fluctuations of blood glucose in patients were measured by a continuous glucose monitoring system (CGMS) for 72 hours. Participants were grouped into tertiles of mean amplitude of glycemic excursions (MAGE) and grouped into HbA1c levels (as ≥6.5% or <6.5%). The MACE of patients, including new-onset myocardial infarction, acute heart failure and cardiac death, was documented during one year follow-up. The relationship of MAGE and HbA1c to the incidence of MACE in elderly AMI patients was analyzed.ResultsIn all participants, a higher MAGE level was associated with the higher GRACE score (r = 0.335, p < 0.001). The rate of MACE by MAGE tertiles (>3.94 mmol/L, 2.55-3.94 mmol/L or <2.55 mmol/L) was 30.2% vs. 14.8% vs. 8.1%, respectively (p = 0.004); by HbA1c category (≥6.5% vs. <6.5%) was 22.7% vs. 14.4%, respectively (p = 0.148). Elderly AMI patients with a higher MAGE level had a significantly higher cardiac mortality. In multivariable analysis, high MAGE level was significantly associated with incidence of MACE (HR 3.107, 95% CI 1.190-8.117, p = 0.021) even after adjusting for GRACE risk score, but HbA1c was not.ConclusionsThe early in-hospital intraday glycemic excursion may be an important predictor of mortality and MACE even stronger than HbA1c in elderly patients after AMI.

Degludec is superior to glargine in terms of daily glycemic variability in people with type 1 diabetes mellitus

“…Therefore, these systems can provide a more accurate means to evaluate the efficacy of glucose lowering therapies within individual participants [11]. Blood glucose variability is an important contributing factor to the severity of coronary artery disease independent of HbA1c [12,13], as well as an independent predictor of mortality [14]. Mean amplitude of glycemic excursions (MAGE) is a marker of daily blood glucose variability relating to higher postprandial blood glucose or hypoglycemia, had a persistent elevation of their serum transaminase, or had renal dysfunction were excluded.…”

Multidimensional effects of metformin in patients with type 2 diabetes

“…Показано, что уровни MAGE >3,94 ммоль/л у пожилых пациентов при дебюте ОИМ на фоне дисгликемии является более мощным по сравнению с НbA 1c (<6,5% и 6,5%) предиктором риска (р=0,004) неблагоприятных ССС в течение первого года [27].…”

Problems of hypoglycemic therapy in diabetic patients with acute coronary syndrome

“…(2013) показали, что тертиль MAGE >3,94 ммоль/л у пожилых пациентов при дебюте ОИМ является более мощным по сравнению с НbA1c (<6,5% и ≥6,5%) предиктором риска (р = 0,004) неблагоприятных ССС (инфаркт миокарда, острая сердечная недостаточ-ность, смерть) в течение первого года после ОИМ [50]. Отметим, что в данном случае речь шла о дисгликемии, т. е. анализировали влияние стрессовой гипергликемии у пациентов без известного в анамнезе СД, а также при его наличии (оценивали по факту проводимой терапии инсу-лином или ПСП либо по критериям ADA).…”

“…Важно, что интервал колебаний гликемии при ОКС на фоне СД по данным «традиционного» самоконтроля (>4,0 ммоль/л) почти совпадает с результатами непрерывного мониторирования гликемии (>3,94 ммоль/л) у лиц с дис-гликемией [50].…”