Stress hyperglycemia and poor outcomes in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis

Abstract

BackgroundHyperglycemia, characterized by elevated blood glucose levels, is frequently observed in patients with acute coronary syndrome, including ST-elevation myocardial infarction (STEMI). There are conflicting sources regarding the relationship between hyperglycemia and outcomes in STEMI patients. We aimed to compile evidence to assess the association between hyperglycemia and adverse outcomes.MethodsWe conducted a comprehensive search for articles on PubMed and Embase using search strategies which yielded 4,061 articles. After full-text screening, 66 articles were included for systematic review, and 62 articles were further selected for meta-analysis.ResultsThe 66 included articles spanned the years 2005–2023. Of these, 45 articles reported admission blood glucose, 13 articles used HbA1c, and 7 articles studied fasting blood glucose. Most studies defined STEMI with primary PCI as their inclusion criteria. Mortality was the most often outcome reported related to hyperglycemia. Overall, 55 (83.3%) studies were at low risk of bias. Both admission and fasting blood glucose were significantly related to short- and long-term mortality after STEMI, with a pooled risk ratio (RR) of 3.02 (95%CI: 2.65–3.45) and 4.47 (95% CI: 2.54–7.87), respectively. HbA1c showed substantial association with long-term mortality (HR 1.69, 95% CI: 1.31–2.18)) with a pooled RR of 1.58 (95% CI 1.26–1.97). In subsequent analyses, admission hyperglycemia was associated with an increased risk of reinfarction (pooled RR 1.69, 95% CI 1.31–2.17), heart failure (pooled RR 1.56, 95% CI: 1.37–1.77), cardiogenic shock (pooled RR 3.68, 95% CI 2.65–5.11), repeat PCI or stent thrombosis (pooled RR 1.99, 95% CI 1.21–3.28), and composite major adverse cardiac and cerebrovascular events (MACCE) (pooled RR 1.99, 95% CI: 1.54–2.58).ConclusionsOur study demonstrated that hyperglycemia has a strong association with poor outcomes after STEMI. Admission and fasting blood glucose are predictors for short-term outcomes, while HbA1c is more appropriate for predicting longer-term outcomes in STEMI patients.Systematic Review RegistrationPROSPERO 2021 (CRD42021292985).

Impact of stress hyperglycemia ratio on mortality in patients with cardiac arrest: insight from American MIMIC-IV database

“…By introducing HbA1c, the SHR, an index of relative glycemia, was developed in an effort to obtain new insights into the relationship between hyperglycemia and patient outcomes. Previous studies had demonstrated that the strong relationship between SHR and poor clinical outcomes in acute coronary syndrome ( 33 – 36 ), acute ischemic stroke ( 13 , 37 ), heart failure and type 2 DM ( 38 ). Our study also demonstrated the strong association between SHR and mortality in cardiac arrest patients.…”

Stress, Hyperglycemia, and Insulin Resistance Correlate With Neutrophil Activity and Impact Acute Myocardial Infarction Outcomes

“…Admission hyperglycemia predicts a poor prognosis in ST-elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (PCI) [ 5 ]. A recent systemic review that utilized a comprehensive meta-analysis of 62 articles to assess various clinical outcomes in STEMI patients concluded that acute hyperglycemia has a strong correlation with negative outcomes after STEMI [ 6 ].…”