Abstract:Aims/Introduction: Admission hyperglycemia is associated with poor outcome in patients with myocardial infarction. The present study evaluated the relationship between admission glucose level and other clinical variables in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Materials and Methods: The 959 consecutive STEMI patients undergoing primary PCI were divided into five groups based on admission glucose levels of <100, 100-139, 140-189, 1… Show more
“…Yet, the clinical and prognostic significance of high APG levels have differed between STEMI and NSTEMI patients [8]. Since several similar studies have been conducted on STEMI patients [2, 4, 5], our study focused on NSTEMI patients undergoing PCI, to explore the effects of APG on the rate of after hospital discharge, and its prognostic value in the absence or presence of DM.…”
Section: Discussionmentioning
confidence: 99%
“…However, most studies have included patients with only ST-elevation myocardial infarction (STEMI) [2, 4, 5] or included both STEMI and non-ST-elevation myocardial infarction (NSTEMI) patients [1, 3, 6–8]. STEMI and NSTEMI are the major types of AMI, and each is associated with different pathophysiological changes, complications, and prognoses [8].…”
BackgroundThe association between admission hyperglycemia and adverse outcomes in patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI) has not been well studied, and the optimal plasma glucose cut-off values for prognosis for NSTEMI patients with and without diabetes have not been determined.MethodsAccording to glucose level and diabetes status, consecutive NSTEMI patients undergoing PCI (n = 890) were divided into four groups: without diabetes mellitus (DM) and admission plasma glucose (APG) <144 or ≥144 mg/dL; or with DM and APG <180 or ≥180 mg/dL. All patients were followed up at 30 days and 3 years after discharge, and the outcomes were assessed.ResultsAdmission hyperglycemia was found in 44 and 28% of the DM and non-DM patients, respectively. Multivariable analyses showed that the APG level was an independent predictor of 30-day and 3-year MACEs. Receiver operating characteristic curve analysis revealed that the appropriate cut-off values were 178 and 145 mg/dL for patients with and without DM, respectively, or 157 mg/dL for all patients.ConclusionsAdmission hyperglycemia may be used to predict 30-day and 3-year MACEs in patients with NSTEMI undergoing PCI, irrespective of diabetes status. However, the optimal admission glucose cut-off values for predicting prognosis differ for patients with or without DM.
“…Yet, the clinical and prognostic significance of high APG levels have differed between STEMI and NSTEMI patients [8]. Since several similar studies have been conducted on STEMI patients [2, 4, 5], our study focused on NSTEMI patients undergoing PCI, to explore the effects of APG on the rate of after hospital discharge, and its prognostic value in the absence or presence of DM.…”
Section: Discussionmentioning
confidence: 99%
“…However, most studies have included patients with only ST-elevation myocardial infarction (STEMI) [2, 4, 5] or included both STEMI and non-ST-elevation myocardial infarction (NSTEMI) patients [1, 3, 6–8]. STEMI and NSTEMI are the major types of AMI, and each is associated with different pathophysiological changes, complications, and prognoses [8].…”
BackgroundThe association between admission hyperglycemia and adverse outcomes in patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI) has not been well studied, and the optimal plasma glucose cut-off values for prognosis for NSTEMI patients with and without diabetes have not been determined.MethodsAccording to glucose level and diabetes status, consecutive NSTEMI patients undergoing PCI (n = 890) were divided into four groups: without diabetes mellitus (DM) and admission plasma glucose (APG) <144 or ≥144 mg/dL; or with DM and APG <180 or ≥180 mg/dL. All patients were followed up at 30 days and 3 years after discharge, and the outcomes were assessed.ResultsAdmission hyperglycemia was found in 44 and 28% of the DM and non-DM patients, respectively. Multivariable analyses showed that the APG level was an independent predictor of 30-day and 3-year MACEs. Receiver operating characteristic curve analysis revealed that the appropriate cut-off values were 178 and 145 mg/dL for patients with and without DM, respectively, or 157 mg/dL for all patients.ConclusionsAdmission hyperglycemia may be used to predict 30-day and 3-year MACEs in patients with NSTEMI undergoing PCI, irrespective of diabetes status. However, the optimal admission glucose cut-off values for predicting prognosis differ for patients with or without DM.
“…Several studies have demonstrated that acute hyperglycemia is a powerful predictor of mortality, larger infarct size and increased risk of cardiovascular complications in myocardial infarction patients regardless of the diabetic state [30][31][32][33][34][35]. For every 18-mg/ dL increase in glucose level, there is a 4% increase in mortality in nondiabetic patients presenting with myocardial infarction [36].…”
“…In particular, hyperglycemia predicts mortality in patients with ACS, including ST-segment elevation myocardial infarction (STEMI), thrombolysis, and percutaneous coronary revascularization [Capes et al 2000;Zeller et al 2005;Pandey et al 2009;Timmer et al 2011;Eitel et al 2012;Planer et al 2013;Chen et al 2014;Ekmekci et al 2014;Lazzeri et al 2014].…”
Section: Prognosismentioning
confidence: 99%
“…In the specific setting of patients with STEMI, elevated plasma glucose levels on admission confirmed to be independent prognosticators of both in-hospital and long-term outcome regardless of diabetic status [Malmberg et al 1999;Chen et al 2014]. …”
Hyperglycemia is a frequent condition in patients with acute coronary syndromes (ACS). Hyperglycemia during ACS is caused by an inflammatory and adrenergic response to ischemic stress, when catecholamines are released and glycogenolysis induced. Although the involved pathophysiological mechanisms have not yet been fully elucidated, it is believed that hyperglycemia is associated with an increase in free fat acids (which induce cardiac arrhythmias), insulin resistance, chemical inactivation of nitric oxide and the production of oxygen reactive species (with consequent microvascular and endothelial dysfunction), a prothrombotic state, and vascular inflammation. It is also related to myocardial metabolic disorders, leading to thrombosis, extension of the damaged area, reduced collateral circulation, and ischemic preconditioning. In the last few years, several observational studies demonstrated that hyperglycemia in ACS is a powerful predictor of survival, increasing the risk of immediate and long-term complications in patients both with and without previously known diabetes mellitus. Glucose management strategies in ACS may improve outcomes in patients with hyperglycemia, perhaps by reducing inflammatory and clotting mediators, by improving endothelial function and fibrinolysis and by reducing infarct size. Recent clinical trials of insulin in ACS have resulted in varying levels of benefit, but the clinical benefit of an aggressive treatment with insulin is yet unproved.
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