BackgroundHyperglycemia in the setting of an acute coronary syndrome (ACS) impacts short term outcomes, but little is known about longer term effects. We therefore designed this study to firstly determine the association between hyperglycemia and short term and longer term outcomes in patients presenting with ACS and secondly evaluate the prognostic role of diabetes, body mass index (BMI) and the novel biomarker Cyr61 on outcomes.MethodsThe prospective Special Program University Medicine-Acute Coronary Syndrome (SPUM-ACS) cohort enrolled 2168 patients with ACS between December 2009 and October 2012, of which 2034 underwent PCI (93.8%). Patients were followed up for 12 months. Events were independently adjudicated by three experienced cardiologists. Participants were recruited from four tertiary hospitals in Switzerland: Zurich, Geneva, Lausanne and Bern. Participants presenting with acute coronary syndromes and who underwent coronary angiography were included in the analysis. Patients were grouped according to history of diabetes (or HbA1c greater than 6%), baseline blood sugar level (BSL; < 6, 6–11.1 and > 11.1 mmol/L) and body mass index (BMI). The primary outcome was major adverse cardiac events (MACE) which was a composite of myocardial infarction, stroke and all-cause death. Secondary outcomes included the individual components of the primary endpoint, revascularisations, bleeding events (BARC classification) and cerebrovascular events (ischaemic or haemorrhagic stroke or TIA).ResultsPatients with hyperglycemia, i.e. BSL ≥ 11.1 mmol/L, had higher levels of C-reactive protein (CRP), white blood cell count (WBC), creatinine kinase (CK), higher heart rates and lower left ventricular ejection fraction (LVEF) and increased N-terminal pro-brain natriuretic peptide. At 30 days and 12 months, those with BSL ≥ 11.1 mmol/L had more MACE and death compared to those with BSL < 6.0 mmol/L or 6.0–11.1 mmol/L (HR-ratio 4.78 and 6.6; p < 0.001). The novel biomarker Cyr61 strongly associated with high BSL and STEMI and was independently associated with 1 year outcomes (HR 2.22; 95% CI 1.33–3.72; Tertile 3 vs. Tertile 1).Conclusions and relevanceIn this large, prospective, independently adjudicated cohort of in all comers ACS patients undergoing PCI, both a history of diabetes and elevated entry glucose was associated with inflammation and increased risk of MACE both at short and long-term. The mediators might involve increased sympathetic activation, inflammation and ischemia as reflected by elevated Cyr61 levels leading to larger levels of troponin and lower LVEF.Trial registration Clinical Trial Registration Number: NCT01000701. Registered October 23, 2009
Background Outcomes after acute coronary syndromes (ACS) are determined by baseline risk profiles, including initial systolic blood pressure (sBP). Herein, we aimed to characterize ACS patients stratified by initial sBP levels and study the relation to inflammation, myocardial injury and post-ACS outcomes. Methods We analysed 4’724 prospectively recruited ACS patients according to invasively assessed sBP (<100, 100-139, and ≥140mmHg) at admission. Biomarkers of systemic inflammation (high-sensitivity C-reactive protein, hs-CRP) and myocardial injury (high-sensitivity cardiac troponin, hs-cTnT) were measured centrally. Major adverse cardiovascular events (MACE; non-fatal myocardial infarction (MI), non-fatal stroke and cardiovascular (CV) death) were externally adjudicated. Results Leukocyte numbers, hs-CRP, hs-cTnT and creatine kinase (CK) levels decreased from low to high sBP strata (ptrend < 0.001). Expectedly, patients with sBP < 100mmHg developed more often cardiogenic shock (CS; p < 0.001), and had a 1.7- and 1.4-fold increased multi-variable-adjusted MACE risk at 30 days (HR 1.68, 95% CI 1.05-2.69, p = 0.031) and one year (HR 1.38, 95% CI 0.92-2.05, p = 0.117). Those with sBP < 100 mmHg and CS showed a higher leukocyte count (p < 0.001), an increased neutrophil-to-lymphocyte-ratio (p = 0.031), and higher hs-cTnT and CK levels relative to those without CS (p < 0.001 and p = 0.002, respectively), whereas hs-CRP levels did not differ. Patients who developed CS had a 3.6- and 2.9-fold increased MACE risk at 30 days (HR 3.58, 95% CI 1.77-7.24, p < 0.001) and at one year (HR 2.94 95% CI, 1.57-5.53, p < 0.001), which was attenuated after controlling for distinct inflammatory profiles. Conclusions In patients with ACS, proxies of systemic inflammation and myocardial injury are inversely associated with sBP, with highest levels in those <100mmHg. If linked to high levels of cellular inflammation, these patients are prone to develop CS and are at high MACE and mortality risk.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.