Effect of glycemic variability on short term prognosis in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions

Abstract

ObjectiveGlycemic variability (GV) still remains unclear whether acute glycemic excursion has the important prognostic significance in ST-segment elevation myocardial infarction (STEMI) patients undergoing p-PCI. So our aim is to assess the prognostic value of GV in STEMI patients undergoing p-PCI.MethodsWe studied 237 STEMI patients undergoing p-PCI, whose clinical and laboratory data were collected. We used a continuous glucose monitoring system (CGMS) to measure the fluctuations of blood glucose. Participants were grouped into diabetes group and non-diabetes group, and grouped into tertiles of mean amplitude of glycemic excursions (MAGE). The major adverse cardiac events (MACE) of patients was documented during in-hospital and 30-day follow-up. The relationship of MAGE and the incidence of MACE were analyzed.ResultsData from 237 subjects were incorporated into the statistical analysis, a higher MAGE level was associated with the higher peak CK-MB values (r = 0.374, P <0.01), and the higher peak cTnI values (r = 0.410, P <0.01). The rate of composite MACE by MAGE tertiles (<2.37 mmol/l, 2.37-3.65 mmol/l and >3.65 mmol/l) was 7.5% vs. 14.1% vs. 22.8%, respectively (P = 0.025); STEMI patients with a higher MAGE level had a significantly higher non-IRA revascularization compared with those with lower MAGE levels (32% vs. 15% vs. 21%, P = 0.037). Moreover, diabetic patients with higher MAGE level had significantly higher incidence of composite MACE and non-IRA revascularization, non-diabetic subjects did not show the similar results. In multivariable logistic analysis, the independent predictors of MACE were: MBG, MAGE and LVEF in diabetic subjects and were MBG and MAGE in nondiabetic subjects. Other factors were not significantly associated with MACE.ConclusionsGreater GV is associated with composite MACE and non-IRA revascularization during in-hospital and 30-day follow-up in unadjusted analyses, especially for diabetic subjects. After multivariable logistic analysis, GV remains an independent prognostic factor for composite MACE in STEMI patients undergoing p-PCI.

Glycaemic variability and Mortality in critically ill patients

“…For coefficient of variation as a parameter of glycemic variability comparable results were observed in Verona diabetes study (10) . When MAGE was used as a parameter of GV Zhang J et al (11) and Su G et al (12) observed comparable results. We observed increased proportionate mortality in 3 rd and 4 th quartiles of SD, the results which were consistent with study of Krinsley JS et al (13) .…”

Glycemic variability in the development of cardiovascular complications in diabetes

“…Of note, MAGEs ≥3.4 mmol/L was an independent predictor of CAD in this population; indeed, among the independent predictors of Gensini Score, the area under the ROC curve for MAGEs (0.618, P = 0.001) was superior to that for HbA1c (0.554, P = 0.129), indicating that the predictable value of MAGEs was even higher than HbA1c . Furthermore, in a cohort of 237 patients with ST segment elevation MI undergoing PCI, a higher GV was demonstrated to be an independent prognostic factor for composite MACE during in‐hospital and 30‐day follow‐up both for diabetic (OR 2.857, 95% CI 1.143‐7.139, P = 0.025) and non‐diabetic patients (OR 2.097, 95% CI 1.093‐4.026, P = 0.026), while HbA1c was not significantly associated with adverse events occurrence . Interestingly a study by Okada et al, enrolling acute coronary syndrome patients who underwent stent implantation and subsequent intravascular ultrasounds after a 9‐month follow‐up, observed that a high GV was an independent determinant of increased lipid and decreased fibrous contents with larger plaque burden, suggesting glucose abnormalities as one of the important factors related to coronary plaque vulnerability .…”

“…13 Furthermore, in a cohort of 237 patients with ST segment elevation MI undergoing PCI, a higher GV was demonstrated to be an independent prognostic factor for composite MACE during in-hospital and 30-day follow-up both for diabetic (OR 2.857, 95% CI 1.143-7.139, P = 0.025) and non-diabetic patients (OR 2.097, 95% CI 1.093-4.026, P = 0.026), while HbA1c was not significantly associated with adverse events occurrence. 65 Interestingly a study by Okada et al, enrolling acute coronary syndrome patients who underwent stent implantation and subsequent intravascular ultrasounds after a 9-month follow-up, observed that a high GV was an independent determinant of increased lipid and decreased fibrous contents with larger plaque burden, suggesting glucose abnormalities as one of the important factors related to coronary plaque vulnerability. 11 An association between GV, even though evaluated by SGBM, and major CV and cerebrovascular events was also demonstrated during a 30-day follow-up in 864 acute coronary syndrome patients (OR 1.97, 95% CI 1.32-6.86; P = 0.02).…”

Effects of the Mean Amplitude of Glycemic Excursions and Vascular Endothelial Dysfunction on Cardiovascular Events in Nondiabetic Patients With Coronary Artery Disease

“…The mean amplitude of glycemic excursion (MAGE) is the mean of blood glucose values exceeding one SD from the 24‐hour mean blood glucose and is used as an index of glycemic variability . According to the scientific literature, the value of MAGE in patients without DM are nearly 30 to 40 mg/dL, and the cutoff value of MAGE for cardiovascular events are considered nearly 60 to 70 mg/dL …”