Acute hyperglycemia is associated with adverse outcome after acute myocardial infarction in the coronary intervention era

Ishihara, Masaharu; Kojima, Sunao; Sakamoto, Tomohiro; Asada, Yujiro; Tei, Chuwa; Kimura, Kazuo; Miyazaki, Shunichi; Sonoda, Masahiro; Tsuchihashi, Kazufumi; Yamagishi, Masakazu; Ikeda, Yoshihiko; Shirai, Mutsunori; Hiraoka, Hisatoyo; Inoue, Takeshi; Saito, Fumio; Ogawa, Hisao

doi:10.1016/j.ahj.2004.12.020

Cited by 163 publications

(104 citation statements)

References 32 publications

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“…ABG ≥ 8.9 mmol/L was found to be an independent prognostic factor of no-reflow phenomenon in the study by Iwakura et al [21]. A similar correlation was reported by Ishihara et al [25] for patients with ABG > 11.1 mmol/L.…”

Section: Discussionsupporting

confidence: 72%

Admission hyperglycemia in patients with acute coronary syndrome complicated by cardiogenic shock

et al. 2015

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Section: Discussionsupporting

confidence: 72%

Admission hyperglycemia in patients with acute coronary syndrome complicated by cardiogenic shock

et al. 2015

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“…Also, despite the lower blood This is the first study to assess the association of glycemic state upon hospital admission with the myocardium area at risk and myocardial salvage in a large cohort of patients with STEMI. Our data suggest that the excessive myocardial damage (5-8) and adverse prognosis (3,5,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) reported in patients with hyperglycemia are the results of a larger myocardial area at risk, and not of a smaller myocardial salvage. Similarly, since there was no association between hyperglycemia and infarct size when adjusting for the area at risk, the current study demonstrates that the association between hyperglycemia and infarct size is dependent on the size of the area at risk, and hyperglycemic patients can therefore be considered to be at higher risk per se.…”

Section: Discussionmentioning

confidence: 83%

“…The mechanisms behind reperfusion injury have not been fully elucidated, but hyperglycemia, which is observed in approximately half of patients with STEMI upon hospital admission (3), may be unfavorable during reperfusion and has been linked to the subsequent injury (4). Previous studies have demonstrated larger infarct size (5)(6)(7)(8) and poorer prognosis in patients with hyperglycemia upon hospital admission compared with patients without hyperglycemia, both in patients with and without diabetes mellitus (3,5,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Until now, the impact of hyperglycemia on myocardial salvage has been evaluated in only a limited number of patients (21), and no data exist regarding the relationship between hyperglycemia and area at risk.…”

mentioning

confidence: 99%

Impact of Acute Hyperglycemia on Myocardial Infarct Size, Area at Risk, and Salvage in Patients With STEMI and the Association With Exenatide Treatment: Results From a Randomized Study

et al. 2014

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Hyperglycemia upon hospital admission in patients with ST-segment elevation myocardial infarction (STEMI) occurs frequently and is associated with adverse outcomes. It is, however, unsettled as to whether an elevated blood glucose level is the cause or consequence of increased myocardial damage. In addition, whether the cardioprotective effect of exenatide, a glucose-lowering drug, is dependent on hyperglycemia remains unknown. The objectives of this substudy were to evaluate the association between hyperglycemia and infarct size, myocardial salvage, and area at risk, and to assess the interaction between exenatide and hyperglycemia. A total of 210 STEMI patients were randomized to receive intravenous exenatide or placebo before percutaneous coronary intervention. Hyperglycemia was associated with larger area at risk and infarct size compared with patients with normoglycemia, but the salvage index and infarct size adjusting for area at risk did not differ between the groups. Treatment with exenatide resulted in increased salvage index both among patients with normoglycemia and hyperglycemia. Thus, we conclude that the association between hyperglycemia upon hospital admission and infarct size in STEMI patients is a consequence of a larger myocardial area at risk but not of a reduction in myocardial salvage. Also, cardioprotection by exenatide treatment is independent of glucose levels at hospital admission. Thus, hyperglycemia does not influence the effect of the reperfusion treatment but rather represents a surrogate marker for the severity of risk and injury to the myocardium.

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“…A diagnosis of unknown DM was made when patients had ≥6.5% (48 mmol/mol) HbA 1c despite no previous history of the disease 13. Acute hyperglycemia was defined as a blood glucose level at admission >198 mg/dL (>11 mmol/L), according to the definition used in previous studies focusing on AMI patients 11, 14, 15, 16. Average chronic glucose levels were estimated by HbA 1c , expressed as percentage value, according to the following validated formula12, 13, 17:

Estimated chronic glucose levels false(mg false/ dL false) = 28.7 \times {HbA}_{1 c} false(% false) - 46.7

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Section: Methodsmentioning

confidence: 99%

Acute Kidney Injury in Diabetic Patients With Acute Myocardial Infarction: Role of Acute and Chronic Glycemia

Marenzi

Cosentino

Milazzo

et al. 2018

JAHA

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BackgroundIn acute myocardial infarction, acute hyperglycemia is a predictor of acute kidney injury (AKI), particularly in patients without diabetes mellitus. This emphasizes the importance of an acute glycemic rise rather than glycemia level at admission. We investigated whether, in diabetic patients with acute myocardial infarction, the combined evaluation of acute and chronic glycemic levels may have better prognostic value for AKI than admission glycemia.Methods and ResultsAt admission, we prospectively measured glycemia and estimated average chronic glucose levels (mg/dL) using glycosylated hemoglobin (HbA1c), according to the following formula: 28.7×HbA1c (%)−46.7. We evaluated the association with AKI of the acute/chronic glycemic ratio and of the difference between acute and chronic glycemia (ΔA−C). We enrolled 474 diabetic patients with acute myocardial infarction. Of them, 77 (16%) experienced AKI. The incidence of AKI increased in parallel with the acute/chronic glycemic ratio (12%, 14%, 22%; P=0.02 for trend) and ΔA−C (13%, 13%, 23%; P=0.01) but not with admission glycemic tertiles (P=0.22). At receiver operating characteristic analysis, the acute/chronic glycemic ratio (area under the curve: 0.62 [95% confidence interval, 0.55–0.69]; P=0.001) and ΔA−C (area under the curve: 0.62 [95% confidence interval, 0.54–0.69]; P=0.002) accurately predicted AKI, without difference in the area under the curve between them (P=0.53). At reclassification analysis, the addition of the acute/chronic glycemic ratio and ΔA−C to acute glycemia allowed proper AKI risk prediction in 16% of patients.ConclusionsIn diabetic patients with acute myocardial infarction, AKI is better predicted by the combined evaluation of acute and chronic glycemic values than by assessment of admission glycemia alone.

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Acute hyperglycemia is associated with adverse outcome after acute myocardial infarction in the coronary intervention era

Cited by 163 publications

References 32 publications

Admission hyperglycemia in patients with acute coronary syndrome complicated by cardiogenic shock

Admission hyperglycemia in patients with acute coronary syndrome complicated by cardiogenic shock

Impact of Acute Hyperglycemia on Myocardial Infarct Size, Area at Risk, and Salvage in Patients With STEMI and the Association With Exenatide Treatment: Results From a Randomized Study

Acute Kidney Injury in Diabetic Patients With Acute Myocardial Infarction: Role of Acute and Chronic Glycemia

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