Predictive value of random blood glucose versus fasting blood glucose on in-hospital adverse events in patients with ST-segment elevation acute myocardial infarction

Abstract

Background: We aim to find out the relationship between random blood glucose (RBG), fasting blood glucose (FBG) and in-hospital adverse events in ST-segment elevation acute myocardial infarction (STEMI) patients. We evaluate and compare the predictive value of RBG and FBG on in-hospital adverse events, and give an appropriate cutoff value of RBG and FBG. Method: A retrospective study enrolled 958 consecutive AMI patients undergoing emergency coronary angiography at Zhongda Hospital were enrolled from January 1, 2016, to December 31, 2018 was performed. RBG and FBG, baseline data and adverse events were recorded. Major adverse cardiovascular and cerebrovascular events (MACCE) were defined as death, nonfatal recurrent myocardial infarction and stroke. Other adverse events included malignant arrhythmia, cardiac shock and hemorrhage. Patients with RBG > 11.1 mmol/L were divided into elevated RBG group. Patients with FBG > 6.1 mmol/L were divided into elevated FBG group. The incidence of in-hospital adverse events were compared in elevated RBG/FBG group and the control group. ROC curve was used to evaluate the predictive value of RBG and FBG on in-hospital adverse events. Result: The incidence of death, hemorrhage, cardiac shock and malignant arrhythmia significantly increases in elevated RBG and FBG group. Binary logistic regression showed that age, hypertension, diabetes, FBG and RBG were independent risk factors for in-hospital adverse events in STEMI patients. The AUC and 95% CI of RBG and FBG in predicting death of AMI patients were 0.789, 0.759~0.816; 0.810, 0.783~0.835, respectively. The cutoff values were 13.82 and 7.35 mmol/L. RBG and FBG also had fine predictive value on cardiac shock and malignant arrhythmia, no statistical difference was found in the predictive value on in-hospital adverse events (P = 0.462, P = 0.570, P = 0.694). Conclusion: Incidence of in-hospital adverse events significantly increases in AMI patients combined with elevated RBG or FBG. Both RBG and FBG were independent risk factors for in-hospital adverse events, they had good value on predicting in-hospital adverse events and there was no statistical difference in their predictive value.

Relationship between hyperglycaemia at admission and prognosis in patients with acute myocardial infarction: a retrospective cohort study

“…Besides, hyperglycaemia is also related to an increase in free fatty acids and prolonged QT interval, which lead to the occurrence of ventricular arrhythmia and the elimination of ischaemic preconditioning 17 18. We observed that the proportion of ventricular arrhythmias in the non-survivors was higher, which was consistent with previous research conclusions that hyperglycaemia was positively correlated with malignant arrhythmias 19…”

“…17 18 We observed that the proportion of ventricular arrhythmias in the non-survivors was higher, which was consistent with previous research conclusions that hyperglycaemia was positively correlated with malignant arrhythmias. 19 We obtained significant cut-off values of admission serum glucose for predicting hospital mortality in patients with AMI with or without diabetes from the ROC curve. Setting different blood glucose targets for patients with and without diabetes in clinical trials of hyperglycaemia in patients with AMI should be taken into consideration, which was consistent with previous study from Li et al 20 Therefore, we distinguished patients with AMI with or without diabetes.…”

Plasma random glucose levels at hospital admission predicting worse outcomes in STEMI patients undergoing PCI: A case series

“…Qin and colleagues from China also studied the relationship of random and fasting blood glucose levels with severity of same 958 acute MI patients and found fasting blood glucose more independently predicted risk factor among them [ 14 ]. While predicting in-hospital mortality, they reported an AUC of 0.789 for random blood glucose and 0.810 for fasting blood glucose, both of which were significantly higher than our study [ 15 ]. Despite the American Diabetes Association recommendations of keeping the therapeutic target of glucose control between 140 and 180 mg/dL during hospital stay and intensive care [ 16 ], there have been studies suggesting higher mortality rates with each 10-mg/dL rise in mean glucose levels [ 17 ].…”

Acute hyperglycemia, a rabble-rouser or innocent bystander? A prospective analysis of clinical implications of acute hyperglycemia in STE-ACS patients

“…In-hospital outcomes and complications such as mortality, cardiogenic shock, and CIN were found to be significantly higher among the stress hyperglycemia group. Qin Y et al [ 17 ] reported acute hyperglycemia in 36.98% of the patient with STEMI, and the area under the curve (AUC) for random blood sugar level was 0.789 [0.759–0.816] for predicting in-hospital death. In addition to random blood sugar, hypertension, DM, age, and fasting blood sugar level were reported to be independent predictors of mortality.…”