Optimal glucose, HbA1c, glucose-HbA1c ratio and stress-hyperglycaemia ratio cut-off values for predicting 1-year mortality in diabetic and non-diabetic acute myocardial infarction patients

Abstract

Background Stress-induced hyperglycaemia at time of hospital admission has been linked to worse prognosis following acute myocardial infarction (AMI). In addition to glucose, other glucose-related indices, such as HbA1c, glucose-HbA1c ratio (GHR), and stress-hyperglycaemia ratio (SHR) are potential predictors of clinical outcomes following AMI. However, the optimal blood glucose, HbA1c, GHR, and SHR cut-off values for predicting adverse outcomes post-AMI are unknown. As such, we determined the optimal blood glucose, HbA1c, GHR, and SHR cut-off values for predicting 1-year all cause mortality in diabetic and non-diabetic ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients. Methods We undertook a national, registry-based study of patients with AMI from January 2008 to December 2015. We determined the optimal blood glucose, HbA1c, GHR, and SHR cut-off values using the Youden’s formula for 1-year all-cause mortality. We subsequently analyzed the sensitivity, specificity, positive and negative predictive values of the cut-off values in the diabetic and non-diabetic subgroups, stratified by the type of AMI. Results There were 5841 STEMI and 4105 NSTEMI in the study. In STEMI patients, glucose, GHR, and SHR were independent predictors of 1-year all-cause mortality [glucose: OR 2.19 (95% CI 1.74–2.76); GHR: OR 2.28 (95% CI 1.80–2.89); SHR: OR 2.20 (95% CI 1.73–2.79)]. However, in NSTEMI patients, glucose and HbA1c were independently associated with 1-year all-cause mortality [glucose: OR 1.38 (95% CI 1.01–1.90); HbA1c: OR 2.11 (95% CI 1.15–3.88)]. In diabetic STEMI patients, SHR performed the best in terms of area-under-the-curve (AUC) analysis (glucose: AUC 63.3%, 95% CI 59.5–67.2; GHR 68.8% 95% CI 64.8–72.8; SHR: AUC 69.3%, 95% CI 65.4–73.2). However, in non-diabetic STEMI patients, glucose, GHR, and SHR performed equally well (glucose: AUC 72.0%, 95% CI 67.7–76.3; GHR 71.9% 95% CI 67.7–76.2; SHR: AUC 71.7%, 95% CI 67.4–76.0). In NSTEMI patients, glucose performed better than HbA1c for both diabetic and non-diabetic patients in AUC analysis (For diabetic, glucose: AUC 52.8%, 95% CI 48.1–57.6; HbA1c: AUC 42.5%, 95% CI 37.6–47. For non-diabetic, glucose: AUC 62.0%, 95% CI 54.1–70.0; HbA1c: AUC 51.1%, 95% CI 43.3–58.9). The optimal cut-off values for glucose, GHR, and SHR in STEMI patients were 15.0 mmol/L, 2.11, and 1.68 for diabetic and 10.6 mmol/L, 1.72, and 1.51 for non-diabetic patients respectively. For NSTEMI patients, the optimal glucose values were 10.7 mmol/L for diabetic and 8.1 mmol/L for non-diabetic patients. Conclusions SHR was the most consistent independent predictor of 1-year all-cause mortality in both diabetic and non-diabetic STEMI, whereas glucose was the best predictor in NSTEMI patients.

Predictive value of the stress hyperglycemia ratio in patients with acute ST-segment elevation myocardial infarction: insights from a multi-center observational study

“…Our findings suggest that the SHR is a better predictor of STEMI prognosis than the ABG level. Consistent with the current study, Sia et al investigated the optimal cut-off value of SHR and ABG for predicting all-cause mortality in patients with AMI who had undergone PCI and found that SHR was better than ABG, regardless of the presence or absence of DM [ 9 ]. Şimşek B et al reported that higher SHR values were associated with an increased risk of no-flow in patients with STEMI after primary PCI and suggested that there were no interactions between SHR and diabetes status [ 24 ].…”

“…The authors reported that SHR is an effective predictor of adverse events in patient with critical illness [ 7 ]. Further studies have demonstrated that the SHR exhibits better predictive value than ABG in cases of AMI [ 8 , 9 ]. However, data regarding the effect of SHR on the prognosis of STEMI remain limited.…”

Short and long-term prognosis of admission hyperglycemia in patients with and without diabetes after acute myocardial infarction: a retrospective cohort study

“…In this study, we observed that elevated fasting blood glucose in AMI has a strong association with worse outcomes. Previous studies have primarily focused on the prognosis value of admission hyperglycemia in both patients with and without diabetes [1][2][3][4]. Some studies showed that persisting hyperglycaemia was a more accurate and stronger independent predictor of risk than admission blood glucose.…”

“…Hyperglycemia during hospital admission is common in patients with AMI and independently associated with worse prognosis [1][2][3][4], although the association may be nonlinear [5], and data conflict as to whether this association varies by diabetes status [4,6,7]. Admission hyperglycemia occurs in 25-50% of patients, depending on the definition of admission hyperglycemia [8].…”

Atherogenic index of plasma for non-diabetic, coronary artery disease patients after percutaneous coronary intervention: a prospective study of the long-term outcomes in China

“…As Yang et al [ 18 ] reported, the TyG index does not accurately predict prognosis for non-diabetic CAD patients. Although, HbA1C has been used for non-diabetic patient prognosis with varying degrees of accuracy [ 30 – 32 ]. Which suggests there is a need to intercalate one (or more) inflammation markers into a cohesive nomogram or with larger datasets into an artificial intelligence model.…”