A meta-analysis on the correlation between admission hyperglycemia and myocardial infarct size on CMRI

Pak, Stella; Yatsynovich, Yan; Markovic, John-Phillip

doi:10.1016/j.hjc.2017.09.009

“…There is controversy about whether elevated blood glucose on admission is merely an expression of severe disease or whether hyperglycemia is causally associated with serious consequences such as complications or death [ 23 – 25 ]. There are several eligible pathophysiological mechanisms potentially mediating a causal relationship.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of stress hyperglycemia ratio on short- and long-term mortality after acute myocardial infarction

Schmitz

¹

,

Freuer

²

,

Harmel

³

et al. 2022

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Aims Prior studies demonstrated an association between hospital admission blood glucose and mortality in acute myocardial infarction (AMI). Because stress hyperglycemia ratio (SHR) has been suggested as a more reliable marker of stress hyperglycemia this study investigated to what extent SHR in comparison with admission blood glucose is associated with short- and long-term mortality in diabetic and non-diabetic AMI patients. Methods The analysis was based on 2,311 AMI patients aged 25–84 years from the population-based Myocardial Infarction Registry Augsburg (median follow-up time 6.5 years [IQR: 4.9–8.1]). The SHR was calculated as admission glucose (mg/dl)/(28.7 × HbA1c (%)—46.7). Using logistic and COX regression analyses the associations between SHR and admission glucose and mortality were investigated. Result Higher admission glucose and higher SHR were significantly and nonlinearly associated with higher 28-day mortality in AMI patients with and without diabetes. In patients without diabetes, the AUC for SHR was significantly lower than for admission glucose (SHR: 0.6912 [95%CI 0.6317–0.7496], admission glucose: 0.716 [95%CI 0.6572–0.7736], p-value: 0.0351). In patients with diabetes the AUCs were similar for SHR and admission glucose. Increasing admission glucose and SHR were significantly nonlinearly associated with higher 5-year all-cause mortality in AMI patients with diabetes but not in non-diabetic patients. AUC values indicated a comparable prediction of 5-year mortality for both measures in diabetic and non-diabetic patients. Conclusions Stress hyperglycemia in AMI patients plays a significant role mainly with regard to short-term prognosis, but barely so for long-term prognosis, underlining the assumption that it is a transient dynamic disorder that occurs to varying degrees during the acute event, thereby affecting prognosis.

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“…In a previous study, in patients with AHG, the proportion of low TIMI flow scores was higher than that in patients with normal blood glucose levels after PCI [16]. Infarct size was larger [17], and the incidence rates of malignant arrhythmia [18] and cardiac shock [19] were also higher in patients with AHG, especially in non-DM patients than in those without AHG [16]. In the current study, CK-MB, cardiac troponin I, and MYO levels were higher in the severe hyperglycemia group of non-DM patients with AMI.…”

Section: Discussionmentioning

confidence: 99%

High admission glucose levels predict worse short-term clinical outcome in non-diabetic patients with acute myocardial infraction: a retrospective observational study

Ding

¹

,

Wu

²

,

Chen

³

et al. 2019

BMC Cardiovasc Disord

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Background Patients with acute myocardial infarction (AMI) often accompanied by admission hyperglycemia, which usually predicts a poor clinical outcomes for non-diabetes mellitus. Appropriate cut-point to identify high risk individuals in these patients remains controversial. Methods One thousand six hundred ninety-eight non-diabetes AMI patients in this retrospective study were divided into 3 groups according to admission glucose levels (euglycemia group≤140 mg/dL, moderate hyperglycemia group 141–179 mg/dL, severe hyperglycemia group≥180 mg/dL). The primary endpoint of this study was all-cause in-hospital mortality rate. In-hospital motality related risk factors was analyzed by multivariate binary logistic regression analyses. Results All myocardial necrosis markers and Log NT-proBNP in severe hyperglycemia group were significantly higher than those in the other 2 groups. Logistic regression showed that independent predictors of the in-hospital mortality rate in non-diabetic patients with AMI were age (OR = 1.057, 95% CI 1.024–1.091, P < 0.001), logarithm of the N-terminal pro-brain natriuretic peptide (OR = 7.697, 95% CI 3.810–15.550, P < 0.001), insufficient myocardial reperfusion (OR = 7.654, 95% CI 2.109–27.779, P < 0.001), percutaneous coronary intervention (OR = 0.221, 95% CI 0.108–0.452, P < 0.001) and admission glucose (as categorical variable). Patients with moderate hyperglycemia (OR = 1.186, 95% CI 0.585–2.408, P = .636) and severe hyperglycemia (OR = 4.595, 95% CI 1.942–10.873, P = 0.001) had a higher all-cause in-hospital mortality rate compared with those with euglycemia after AMI in non-diabetic patients. Conclusions The all-cause in-hospital mortality risk increases remarkably as admission glucose levels elevated in non-diabetic patients with AMI, especially in patients with admission glucose levels ≥180 mg/dL. Severe admission hyperglycemia could be regarded as prospective high-risk marker for non-diabetic AMI patients.

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“…Yacov et al reported that admission hyperglycemia was an independent risk factor for acute kidney injury in nondiabetic ST-segment elevation myocardial infarction patients undergoing primary PCI [ 14 ]. Stella et al performed a meta-analysis on the relationship between admission hyperglycemia and myocardial infarct size using cardiovascular magnetic resonance imaging (CMRI) and found that the size of myocardial infarct detected on cardiovascular magnetic resonance positively correlated with admission hyperglycemia in patients with acute myocardial infarction [ 15 ]. Ozge et al reported that elevated admission BG level attenuated the coronary collateral flow in patients with ST-elevation myocardial infarction [ 16 ].…”

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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A meta-analysis on the correlation between admission hyperglycemia and myocardial infarct size on CMRI

Cited by 13 publications

References 9 publications

Prognostic value of stress hyperglycemia ratio on short- and long-term mortality after acute myocardial infarction

Prognostic value of stress hyperglycemia ratio on short- and long-term mortality after acute myocardial infarction

High admission glucose levels predict worse short-term clinical outcome in non-diabetic patients with acute myocardial infraction: a retrospective observational study

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

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