Prognostic Value of the Acute-to-Chronic Glycemic Ratio at Admission in Acute Myocardial Infarction: A Prospective Study

Marenzi, Giancarlo; Cosentino, Nicola; Milazzo, Valentina; Metrio, Monica De; Cecere, Milena; Mosca, Susanna; Rubino, Mara; Campodonico, Jeness; Moltrasio, Marco; Marana, Ivana; Grazi, Marco; Lauri, Gianfranco; Bonomi, Alice; Veglia, Fabrizio; Manfrini, Roberto; Bartorelli, Antonio L.

doi:10.2337/dc17-1732

Cited by 85 publications

(109 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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].…”

Section: Discussionmentioning

confidence: 99%

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

Zhu

Liu

Meng

et al. 2020

Cardiovasc Diabetol

View full text Add to dashboard Cite

Background: Left ventricular systolic dysfunction (LVSD) occurs frequently after acute ST-segment elevation myocardial infarction (STEMI). The predisposing factors and underlying mechanism of post-infarct LVSD are not fully understood. The present study mainly investigated the correlation between glycaemic gap, a novel index of stressinduced hyperglycaemia (SIH), and post-infarct LVSD. Methods: A total of 274 first STEMI patients were enrolled in this cross-sectional study. Transthoracic echocardiography was performed within 48 h after admission and at 6 months after discharge to obtain left ventricular ejection fraction (LVEF). The change in LVEF was calculated as LVEF at 6 months after discharge minus baseline LVEF. Additionally, post-infarct LVSD was defined as LVEF ≤ 50%. Most importantly, glycaemic gap was calculated as admission blood glucose (ABG) minus the estimated average glucose over the previous 3 months. Results: In patients without diabetes mellitus (DM), multivariate linear regression analysis revealed that both glycaemic gap (Beta = − 1.214, 95% CI − 1.886 to − 0.541, p < 0.001) and ABG (Beta = − 1.124, 95% CI − 1.795 to − 0.453, p = 0.001) were associated with change in LVEF. In DM patients, only glycaemic gap was still associated with change in LVEF, although this association was not observed in univariate linear regression analysis. Regarding the association between SIH and post-infarct LVSD, multivariate logistic regression analysis revealed that both glycaemic gap (OR = 1.490, 95% CI 1.043 to 2.129, p = 0.028) and ABG (OR = 1.600, 95% CI 1.148 to 2.229, p = 0.005) were associated with an increased risk of having post-infarct LVSD in non-DM patients. However, after multivariate adjustment in DM patients, only glycaemic gap (OR = 1.399, 95% CI 1.021 to 1.919, p = 0.037) remained associated with an increased risk of having post-infarct LVSD. Furthermore, the predictive value of glycaemic gap for postinfarct LVSD was not inferior to ABG in non-DM patients (p = 0.499), and only glycaemic gap, instead of ABG, could significantly predict post-infarct LVSD in DM patients (AUC = 0.688, 95% CI 0.591 to 0.774, p = 0.002). Conclusions: Glycaemic gap was strongly associated with a change in LVEF and an increased risk of having postinfarct LVSD in patients following STEMI. In STEMI patients with DM, glycaemic gap could provide more valuable information than ABG in identifying patients at high risk of developing post-infarct LVSD.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Zhu

Liu

Meng

et al. 2020

Cardiovasc Diabetol

View full text Add to dashboard Cite

show abstract

“…Especially during hospitalization, it is a strong predictable factors for fatal outcomes in patients with AMI [5,17]. But A/C glycemic ratio was reported to be a better predictor of in-hospital morbidity and mortality than glycaemia at admission [3]. And positive correlation of serum HbA1c with the presence of carotid plaque [1] and vulnerable plaque in ACS were reported in previous studies [16].…”

Section: Discussionmentioning

confidence: 88%

The association between glucose-related variables and plaque morphology in patients with ST-segment elevated myocardial infarction

Liu

Wang

Cui

et al. 2020

Cardiovasc Diabetol

View full text Add to dashboard Cite

Background: Plaque rupture (PR) and plaque erosion (PE) are main causes of acute myocardial infarction with different demographic and histology characteristics and need different treatment strategy. PR and PE can be identified with optical coherence tomography (OCT) accurately, but convenient and effective noninvasive markers for them are rarely found. History of diabetes mellitus (DM) was reported to be a potential predictor of PR in ST-segment elevated myocardial infarction (STEMI) patients, but the predictive value of other glucose-related variables for it is still uncertain. Present study aimed to clear the relationship between some glucose-related variables and plaque morphology in patients with STEMI. Methods: We consecutively enrolled 872 STEMI patients and divided them into PR group (n = 616) and PE group (n = 256) based on OCT diagnostic criteria. The relationship of glucose-related variables, including random plasma glucose on admission (ARPG), glycosylated hemoglobin (HbA1c), post-PCI fasting plasma glucose (PFPG), DM history, glucose variable tendency (GVT) and the acute-to-chronic glycemic ratio (A/C), to the PR risk of STEMI patients was analyzed. The correlation between the glucose-related variables and plaque morphology was analyzed meanwhile. Results: Among the glucose-related variables, ARPG and GVT were confirmed to be independent predictors for PR after adjusting for other traditional risk factors in nondiabetic patients. The higher the ARPG level, the more PR risk the STEMI patients had. And high HbA1c and APPG were demonstrated to have a weak and positive correlation with lipid constituents and stenosis degree of culprit vessel. Conclusions: Compared to HbA1c, DM history, and some other glucose-related variables, ARPG and GVT were risk factors for PR in STEMI patients, especially those without DM. And high HbA1c and ARPG were positively correlated with the development of vulnerable plaque in culprit vessels. Trial registration Present study is a retrospective one and the population came from the EROSION study of our center previously. It was approved by the Ethics Committee of the Second Affiliated Hospital of Harbin Medical University (Approval reference number, KY2017-249), and all patients provided written informed consent prior to the inclusion in the study and the investigation conformed to the principles outlined in the Declaration of Helsinki.

show abstract

“…Diabetes mellitus is a multifactorial metabolic disease and growing evidence shows that it is characterized by a state of sub-clinical in ammation [5], as re ected by chronic high levels of hs-CRP [6]. In AMI, patients with DM show a more severe in ammatory condition than those without DM [25], and this may, at least in part, explain their higher short-term and long-term mortality risk [26,27]. However, whether hs-CRP during AMI carries a different prognostic relevance in DM and non-DM patients is still a controversial issue.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Admission High-Sensitivity C-Reactive Protein in Acute Myocardial Infarction Patients With and Without Diabetes Mellitus

Lucci

Cosentino

Genovese

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background: High-sensitivity C-reactive protein (hs-CRP) elevation frequently occurs in acute myocardial infarction (AMI) and is associated with adverse outcomes. Since diabetes mellitus (DM) is characterized by an underlying chronic inflammation, hs-CRP may have a different prognostic power in AMI patients with and without DM.Methods: We prospectively included 2,064 AMI patients; hs-CRP was measured at hospital admission. Patients were grouped according to hs-CRP quartiles and DM status. The primary endpoint was a composite of in-hospital mortality, cardiogenic shock, and acute pulmonary edema. Two-year all-cause mortality was the secondary endpoint.Results: Twenty-six percent (n=548) of patients had DM and they had higher hs-CRP levels than non-DM patients (5.32 vs. 3.24 mg/L; P<0.0001). The primary endpoint incidence in the overall population (7%, 9%, 13%, 22%; P for trend <0.0001), in DM (14%, 9%, 21%, 27%; P=0.0001), and non-DM (5%, 8%, 10%, 19%; P<0.0001) patients increased in parallel with hs-CRP quartiles. The adjusted risk of the primary endpoint increased in parallel with hs-CRP quartiles in DM and non-DM patients but this relationship was less evident in DM patients. In the overall population, the adjusted OR of the primary endpoint associated with an hs-CRP value >2 mg/L was 2.10 (95% CI 1.46-3.00). For the same risk, hs-CRP was 7 and 2 mg/L in patients with and without DM. A similar behavior was observed for the secondary endpoint when the HR associated with an hs-CRP value >2 mg/L found in the overall population was 2.25 (95% CI 1.57-3.22). For the same risk, hs-CRP was 8 and 1.5 mg/L in DM and non-DM patients.Conclusions: This study shows that hs-CRP predicts in-hospital outcome and two-year mortality in AMI patients with and without DM. However, in DM patients, the same risk of developing events as in non-DM patients is associated to higher hs-CRP levels.

show abstract

Prognostic Value of the Acute-to-Chronic Glycemic Ratio at Admission in Acute Myocardial Infarction: A Prospective Study

Abstract: In AMI patients with diabetes, A/C glycemic ratio is a better predictor of in-hospital morbidity and mortality than glycemia at admission.

Cited by 85 publications

References 34 publications

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

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

The association between glucose-related variables and plaque morphology in patients with ST-segment elevated myocardial infarction

Prognostic Impact of Admission High-Sensitivity C-Reactive Protein in Acute Myocardial Infarction Patients With and Without Diabetes Mellitus

Contact Info

Product

Resources

About