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

Jaskiewicz, Filip; Supel, Karolina; Koniarek, Włodzimierz; Zielińska, Marzenna

doi:10.5603/cj.a2014.0087

Cited by 6 publications

(5 citation statements)

References 29 publications

(34 reference statements)

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“…Accordingly, these patients also had a higher maximal creatinine kinase rise, lower ejection fraction and increased NT-BNP compared to the other two groups. Similarly, in previously published small series of patients with cardiogenic shock who do have markedly elevated catecholamines, entry glucose was also predictive [22].…”

Section: Discussionmentioning

confidence: 68%

Diabetes and baseline glucose are associated with inflammation, left ventricular function and short- and long-term outcome in acute coronary syndromes: role of the novel biomarker Cyr 61

Winzap

Davies

Klingenberg

et al. 2019

Cardiovasc Diabetol

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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

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Section: Discussionmentioning

confidence: 68%

Diabetes and baseline glucose are associated with inflammation, left ventricular function and short- and long-term outcome in acute coronary syndromes: role of the novel biomarker Cyr 61

Winzap

Davies

Klingenberg

et al. 2019

Cardiovasc Diabetol

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“…Furthermore, the risk for repeat revascularization has been related to DM severity, with insulin-dependent DM having the highest risk factor for repeat revascularization ( 32 ). Elevated glucose level is markedly related to sympathetic stimulation, and catecholamine can stimulate glucose release and control hyperglycemia ( 33 ). Mechanistically, an increase in the incidence of MACE, mortality, and stroke among DM patients might be a result of direct glucotoxic effects, which lead to the attenuation of endothelium-dependent vasodilatation and myocardial perfusion damage ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

Section: Dm and Dnlmentioning

confidence: 99%

Primary Percutaneous Coronary Intervention in Patients With Type 2 Diabetes With Late/Very Late Stent Thrombosis and de novo Lesions: A Single-Center Observational Cohort Study of Clinical Outcomes and Influencing Factors

Zhao

Liao

et al. 2021

Front. Cardiovasc. Med.

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Background: This study compared differences in the risk factors and clinical outcomes of primary percutaneous coronary intervention (PCI) in type 2 diabetes mellitus (DM) and non-DM patients with de novo lesions (DNLs) and late or very late stent thrombosis (LST/VLST).Methods: We used angiography to screen 4,151 patients with acute coronary syndrome for DNL and LST/VLST lesions. Overall, 3,941 patients were included in the analysis and were allocated to the DM (n = 1,286) or non-DM (n = 2,665) group at admission. The primary endpoint was a composite of major adverse cardiovascular events (MACEs), defined as death, myocardial infarction, revascularization, and ischemic stroke, within a median follow-up period of 698 days.Results: In the group with a total white blood cell count >10 × 109/L (P = 0.004), a neutral granular cell count >7 × 109/L (P = 0.030), and neutrophil–lymphocyte ratio >1.5 (P = 0.041), revascularization was better for DNL than for LST/VLST lesions. Among DM patients with DNLs, each unit increase in age was associated with a 53.6% increase in the risk of MACEs [hazard ratio (HR): 1.536, 95% confidence interval (CI), 1.300–1.815, P < 0.0001]. Older age (≥65 years) was associated with a significantly greater risk of MACEs (P < 0.0001). Furthermore, each standard deviation (SD) increase in the level of peak white blood cell counts was associated with a 50.1% increase in the risk of MACEs (HR, 1.501; 95% CI, 1.208–1.864; P = 0.0002). When stratifying the DM population with DNLs according to the D-dimer baseline and peak levels <0.5 vs. ≥0.5 mg/L, the high D-dimer group at baseline had a 2.066-fold higher risk of MACEs (P < 0.0001), and the high peak level D-dimer group had a 1.877-fold higher risk of MACEs (P = 0.001) compared to the low-level groups. Among DM patients with LST/VLST, each unit increase in age was associated with a 75.9% increase in the risk of MACEs (HR: 1.759, 95% CI, 1.052–2.940, P = 0.032). Furthermore, for each SD increase in the peak D-dimer level, the risk of MACEs increased by 59.7% (HR, 1.597; 95% CI, 1.110–2.295; P = 0.041).Conclusion: Following successful primary PCI, the measurement of baseline and peak D-dimer values may help identify individuals at high cardiovascular risk. This suggests a potential benefit of lowering D-dimer levels among T2DM patients with DNL. Furthermore, age and the peak D-dimer values may facilitate the risk stratification of T2DM patients with LST/VLST.

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“…Furthermore, the risk for repeat revascularization has been related to DM severity, with insulin-dependent DM having the highest risk factor for repeat revascularization [15]. Elevated glucose level is markedly related to sympathetic stimulation, and catecholamine can stimulate glucose release and control hyperglycemia [16][17][18]. Mechanistically, an increase in the incidence of MACE, mortality, and stroke among DM patients might be a result of direct glucotoxic effects, which lead to the attenuation of endothelium-dependent vasodilatation and myocardial perfusion damage [19][20][21].…”

Section: Dm and Dnlmentioning

confidence: 99%

Clinical Outcomes in type 2 Diabetes with in-stent Restenosis and Late/very Late Stent Thrombosis Undergoing Primary Percutaneous Coronary Intervention: A Single-center Observational Cohort Study

Zhao¹,

Zhou²,

Tan³

et al. 2020

Preprint

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BACKGROUND: This study aimed to compare differences in the risk factors and clinical outcomes of type 2 diabetes mellitus (DM) and non-DM patients with de novo lesions (DNL), definite in-stent restenosis (ISR), and late or very late stent thrombosis (LST/VLST). METHODS: A total of 4151 patients with acute coronary syndrome were screened angiographically to determine DNL, ISR, and LST/VLST. A total of 3976 patients were included in the analysis and divided into DM (n=1302) or non-DM (n=2674) group at admission. The primary endpoint was a composite of major adverse cardiovascular events (MACEs), defined as death, myocardial infarction, revascularization, and ischemic stroke within a 1-year follow-up period. RESULTS: In the group with total white blood cell count >10 10^9/L (p=0.004), neutral granular cell count >7 10^9/L (p=0.030), neutrophil-lymphocyte ratio >1.5 (p=0.041), DNL outperformed LST/VLST lesions in terms of revascularization at a median follow-up of 698 days. Among patients with DNL, the incidences of MACEs (log-rank p=0.0002), all-cause death (log-rank p=0.00032), cardiac-related death (log-rank p=0.021), and revascularization (log-rank p=0.029) were significantly lower in the non-DM group than in the DM group. However, no difference was observed in the event rates of endpoints among patients with ISR and LST/VLST between the non-DM and DM groups. Furthermore, among DM patients, there was a critically higher cumulative incidence of revascularization (log-rank p=0.0002) in the subgroup with ISR lesions and higher rate of ischemic stroke (log-rank p=0.033) in the subgroup with LST/VLST lesions. CONCLUSION: This study found that DM patients have a higher incidence of composite clinical outcomes than non-DM patients among patients with DNL. Compared with patients with DNL, patients with ISR lesions and LST/VLST lesions had more incidence of revascularization by long-term follow up. Thus, ISR and LST/VLST lesions are critical problems after coronary stenting, especially among DM patients.

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

Abstract: (Cardiol J 2015; 22, 3: 290-295)

Cited by 6 publications

References 29 publications

Diabetes and baseline glucose are associated with inflammation, left ventricular function and short- and long-term outcome in acute coronary syndromes: role of the novel biomarker Cyr 61

Diabetes and baseline glucose are associated with inflammation, left ventricular function and short- and long-term outcome in acute coronary syndromes: role of the novel biomarker Cyr 61

Primary Percutaneous Coronary Intervention in Patients With Type 2 Diabetes With Late/Very Late Stent Thrombosis and de novo Lesions: A Single-Center Observational Cohort Study of Clinical Outcomes and Influencing Factors

Clinical Outcomes in type 2 Diabetes with in-stent Restenosis and Late/very Late Stent Thrombosis Undergoing Primary Percutaneous Coronary Intervention: A Single-center Observational Cohort Study

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