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

Şimşek, Barış; Çınar, Tufan; Ozan, Veysel; İnan, Tanık D.; Zeren, Gönül; Avcı, İlhan İlker; Güngör, Barış; Yılmaz, Fatih; Tanboğa, İbrahi̇m Hali̇l; Karabay, Can Yücel

doi:10.33963/kp.15736

“…Consistent with the current study, Sia et al investigated the optimal cut-off value of SHR and ABG for predicting all-cause mortality in patients with AMI who had undergone PCI and found that SHR was better than ABG, regardless of the presence or absence of DM [ 9 ]. Şimşek B et al reported that higher SHR values were associated with an increased risk of no-flow in patients with STEMI after primary PCI and suggested that there were no interactions between SHR and diabetes status [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Predictive value of the stress hyperglycemia ratio in patients with acute ST-segment elevation myocardial infarction: insights from a multi-center observational study

Xu

¹

,

Yang

²

,

Zhu

³

et al. 2022

Cardiovasc Diabetol

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Background Stress hyperglycemia is a strong predictor of adverse outcomes in patients with acute myocardial infarction (AMI). Recently, the stress hyperglycemia ratio (SHR) has been designed as an index to identify acute hyperglycemia with true risk; however, data regarding the impact of SHR on the prognosis of ST-segment elevation myocardial infarction (STEMI) remains limited. This study aimed to evaluate the predictive value of the SHR in patients with acute STEMI and to assess whether it can improve the predictive efficiency of the Thrombolysis in Myocardial Infarction (TIMI) risk score. Methods This study included 7476 consecutive patients diagnosed with acute STEMI across 274 emergency centers. After excluding 2052 patients due to incomplete data, 5417 patients were included in the final analysis. Patients were divided into three groups according to SHR tertiles (SHR1, SHR2, and SHR3) and were further categorized based on diabetes status. All patients were followed up for major cardiovascular adverse events (MACEs) and all-cause mortality. Results After 30 days of follow-up, 1547 MACEs (28.6%) and 789 all-cause deaths (14.6%) occurred. The incidence of MACEs was highest among patients in the SHR3 group with diabetes mellitus (DM) (42.6%). Kaplan–Meier curves demonstrated that patients with SHR3 and DM also had the highest risk for MACEs when compared with other groups (p < 0.001). Moreover, C-statistics improved significantly when SHR3 was added into the original model: the ΔC-statistics (95% confidence interval) were 0.008 (0.000–0.013) in the total population, 0.010 (0.003–0.017) in the DM group, and 0.007 (0.002–0.013) in the non-DM group (all p < 0.05). In the receiver operating characteristic analysis, the area under the curve (AUC) for the original TIMI risk score for all-cause death was 0.760. When an SHR3 value of 1 point was used to replace the history of DM, hypertension, or angina in the original TIMI risk score, the Delong test revealed significant improvements in the AUC value (∆AUC of 0.009, p < 0.05), especially in the DM group (∆AUC of 0.010, p < 0.05). Conclusion The current results suggest that SHR is independently related to the risks of MACEs and mortality in patients with STEMI. Furthermore, SHR may aid in improving the predictive efficiency of the TIMI risk score in patients with STEMI, especially those with DM.

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“…Fang et al studied in-hospital peak glycemia for predicting no-reflow phenomenon in diabetic patients with ST-elevation myocardial infarction treated with primary PCI and concluded that spontaneous reperfusion rate of hyperglycemia combined with acute ST-segment elevation myocardial infarction was low [ 20 ]. Microvascular dysfunction has also been confirmed in acute myocardial infarction patients with hyperglycemia in the study of Simsek et al that evaluated the association of acute-to-chronic glycemic ratio and no reflow in patients with ST-segment elevation myocardial infarction undergoing primary PCI [ 21 ]. Shock index on admission was associated with coronary slow/no reflow in patients with acute myocardial infarction undergoing emergent PCI.…”

Section: Discussionmentioning

confidence: 99%

Effect of Admission Hyperglycemia on Short-Term Prognosis of Patients with Non-ST Elevation Acute Coronary Syndrome without Diabetes Mellitus

Liu

¹

,

Li

²

,

Xing

³

et al. 2021

Journal of Diabetes Research

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Objective. To evaluate the effect of admission hyperglycemia on the short-term prognosis of patients with non-ST elevation acute coronary syndrome (NSTE-ACS) without diabetes mellitus. Methods. The clinical data of 498 patients with NSTE-ACS admitted to the Department of Cardiology of the First Affiliated Hospital of Henan University of Science and Technology between March 2018 and November 2020 were analyzed. Based on the blood glucose (BG) level at admission, patients were divided into three groups: A ( BG < 7.8 mmol/L), B ( 7.8 mmol / L ≤ BG < 11.1 mmol / L ), and C ( BG ≥ 11.1 mmol/L). The clinical data of the three groups were compared. Results. There was no significant difference between the three groups in terms of age, sex, hypertension, hyperlipidemia, smoking, and history of myocardial infarction ( p > 0.05 ). However, there were significant differences in the incidences of multivessel disease, renal insufficiency, pump failure, and emergency percutaneous coronary intervention, and levels of high-sensitivity C-reactive protein, cardiac troponin T, and creatine kinase isoenzyme MB among the three groups ( p < 0.05 for all). The incidences of severe pump failure, malignant arrhythmias, and death were significantly higher in groups B and C compared to group A ( p < 0.05 ). Additionally, the incidences of severe pump failure, malignant arrhythmias, and death were significantly higher in group C compared to group B ( p < 0.05 ). Multivariate logistic regression analysis showed that hyperglycemia, renal insufficiency, Killip grade III/IV, and age were risk factors of in-hospital death. Conclusion. Hyperglycemia at admission is a risk factor for adverse in-hospital clinical outcomes in patients with NSTE-ACS.

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“… 2 Numerous clinical and angiographic factors have been shown to be associated with no-reflow, including advanced age, a reperfusion time > 6 h, Killip Class ⩾ 3, long lesion length, high thrombus burden (grade ⩾ 3), a high admission glucose to estimated average glucose ratio and PRECISE-DAPT score. 3 – 6 Moreover, there is evidence of a correlation between no-reflow and reduced left ventricular function, worse clinical outcome and higher mortality. 7 …”

Section: Introductionmentioning

confidence: 99%

Comparison of angiographic results and clinical outcomes of no-reflow after stenting in left anterior descending (LAD) versus non-LAD culprit STEMI

Khan

¹

,

Kumar

²

,

Shah

³

et al. 2022

SAGE Open Medicine

3

0

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Objectives: No-reflow is a complication that frequently occurs after stenting during primary percutaneous coronary intervention. In this study, we focused on angiographic results and clinical outcomes after no-reflow in the left anterior descending (LAD) artery versus non–left anterior descending artery ST-elevation myocardial infarction (STEMI). Methods: In this prospective study, a total of 201 patients who had developed no-reflow during primary percutaneous coronary intervention were enrolled. The patients were divided into left anterior descending artery culprit and non-left anterior descending artery culprit groups. The primary endpoints were final thrombolysis in myocardial infarction flow, corrected thrombolysis in myocardial infarction frame count and final myocardial blush grade. Secondary endpoints were major adverse cardiovascular events in-hospital and at 1 month. Results: Out of the 201 patients, 60.19% had culprit left anterior descending artery. Pulse rate, baseline systolic and diastolic blood pressure, single-vessel disease, left ventricular ejection fraction <30%, baseline thrombolysis in myocardial infarction I flow and final thrombolysis in myocardial infarction II flow (24.8% vs 11.3%, p = .017), and thrombolysis in myocardial infarction frame count (28.17 ± 11.86 vs 24.38 ± 9.05, p = .016) were significantly higher in the left anterior descending artery group. In contrast, baseline Killip Class I, three-vessel disease, baseline thrombolysis in myocardial infarction II flow, final thrombolysis in myocardial infarction III flow (74.4% vs 87.5%, p = .024) and left ventricular ejection fraction >40% were significantly greater in the non–left anterior descending artery group. However, for both in-hospital and at 30 days, overall major adverse cardiovascular event was similar in the two groups. The demographics, clinical and medication profiles and the routes used to treat no-reflow were all comparable in both groups. Conclusions: No-reflow in left anterior descending artery ST-elevation myocardial infarction is associated with lower final thrombolysis in myocardial infarction III flow, higher thrombolysis in myocardial infarction frame count and relatively lower Grade III myocardial blush than non-left anterior descending artery ST-elevation myocardial infarction with subsequent lower left ventricular ejection fraction and a higher frequency of in-hospital heart failure and hospitalisation due to heart failure.

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

Cited by 23 publications

References 24 publications

Predictive value of the stress hyperglycemia ratio in patients with acute ST-segment elevation myocardial infarction: insights from a multi-center observational study

Predictive value of the stress hyperglycemia ratio in patients with acute ST-segment elevation myocardial infarction: insights from a multi-center observational study

Effect of Admission Hyperglycemia on Short-Term Prognosis of Patients with Non-ST Elevation Acute Coronary Syndrome without Diabetes Mellitus

Comparison of angiographic results and clinical outcomes of no-reflow after stenting in left anterior descending (LAD) versus non-LAD culprit STEMI

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

Cited by 23 publications

References 24 publications

Predictive value of the stress hyperglycemia ratio in patients with acute ST-segment elevation myocardial infarction: insights from a multi-center observational study

Predictive value of the stress hyperglycemia ratio in patients with acute ST-segment elevation myocardial infarction: insights from a multi-center observational study

Effect of Admission Hyperglycemia on Short-Term Prognosis of Patients with Non-ST Elevation Acute Coronary Syndrome without Diabetes Mellitus

Comparison of angiographic results and clinical outcomes of no-reflow after stenting in left anterior descending (LAD) versus non-LAD culprit STEMI

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Product

Resources

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