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

Abstract

Objective Admission hyperglycemia is associated with poor prognosis in patients with acute myocardial infarction (AMI), but the effects of baseline diabetes status on this association remain elusive. We aim to investigate the impact of admission hyperglycemia on short and long-term outcomes in diabetic and non-diabetic AMI patients. Methods In this retrospective cohort study, 3330 patients with regard to first-time AMI between July 2012 and July 2020 were identified. Participants were divided into two groups according to diabetes status (1060 diabetic patients and 2270 non-diabetic patients). Thereafter, they were divided into four groups according to diabetes status-specific cutoff values of fasting blood glucose (FBG) identified by restricted cubic spline. Short-term outcomes included in-hospital death and cardiac complications. Long-term outcomes were all-cause mortality and major adverse cardiovascular events (MACE). Inverse probability of treatment weighting (IPTW) was conducted to adjust for baseline differences among the groups, followed by a weighted Cox proportional hazards regression analysis to calculate hazard ratios and 95% confidence intervals for all-cause mortality associated with each FBG category. Subgroup analysis and sensitivity analysis were performed to test the robustness of our findings. Results During a median follow-up of 3.2 years, 837 patients died. There was a significant interaction between diabetes status and FBG levels for all-cause mortality during long-term follow-up (p-interaction < 0.001). Moreover, restricted cubic spline curves for the association between FBG and all-cause mortality followed a J shape in patients with diabetes and a non-linear in patients without diabetes. Kaplan–Meier analysis demonstrated greater survival in non-hyperglycemia patients compared to hyperglycemia patients for both diabetic and non-diabetic patients groups. Survival of hyperglycemia patients without diabetes greater than in hyperglycemia patients with diabetes. In the weighted Multivariable cox analysis, admission hyperglycemia predicted higher short and long-term mortality. Subgroup analysis and sensitivity analysis showed the robustness of the results. Conclusions The inflection points of FBG level for poor prognosis were 5.60 mmol/L for patients without diabetes and 10.60 mmol/L for patients with diabetes. Admission hyperglycemia was identified as an independent predictor of worse short and long-term outcomes in AMI patients, with or without diabetes. These findings should be explored further.

Plasma Metabolic Profiling and Multiclass Diagnostic Model Development for Stable Angina Pectoris and Acute Myocardial Infarction

“…Inflammation promotes the progression of atherosclerosis during clinical stability and triggers instability and acute coronary syndrome. Although hs-CRP is a benchmark biomarker for CHD inflammatory risk, it is possibly a downstream indicator of inflammatory pathway activation rather than a direct causative factor of cardiovascular events. , Furthermore, our study revealed that blood glucose levels in patients with AMI were higher than those in healthy individuals and patients with SAP, possibly as a transient response to ischemic injury, independent of a history of diabetes . Elevation in blood glucose is strongly correlated with the worsening of conditions as hyperglycemia can further disrupt the dynamic balance of endothelial cells, amplify inflammation, and cause a prothrombotic state and ischemic burden .…”

Influence of Metabolic Syndrome on the Long-Term Prognosis of Patients with Myocardial Infarction: A Meta-Analysis

“…An early study in patients after acute MI showed that abdominal obesity may be an independent predictor of all-cause mortality in men and perhaps also in women [30]. Also, hyperglycemia, particularly on admission, has been related to a poor short-term and long-term prognosis in patients with acute MI [31], even in patients without diabetes [32]. In addition, a recent study suggested that dyslipidemia characterized by high triglyceride and low non-HDL cholesterol may be important residual risk factors for the recurrence of MI in patients after acute MI [33].…”

Effect of dapagliflozin on the prognosis of patients with acute myocardial infarction undergoing percutaneous coronary intervention

“…HF was diagnosed as per the typical symptoms, signs, and laboratory tests, including orthopnea, acute pulmonary edema, and brain natriuretic peptide (BNP) testing. MI was considered as [ 1 ] symptoms of ischemic chest pain; [ 2 ] a characteristic ST-T dynamic evolution on the electrocardiogram, or with abnormal q waves; [ 3 ] serum myocardial enzyme spectrum increased and decreased. Nonfatal MI was diagnosed as new pathological Q waves in ≥ 2 contiguous electrocardiogram leads according to the previous study [ 13 ].…”

“…Despite extensive progress in the field of interventional therapy, the incidence of major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI) is still high. Risk factors such as diabetes, chronic kidney disease (CKD), atrial fibrillation, high coronary disease burden, low ejection fraction, and advanced age may worsen the prognosis of such patients [1][2][3]. SGLT2 inhibitors (SGLT2i) have been shown to improve cardiorenal endpoints in patients with type 2 diabetes (T2DM), CKD, and chronic heart failure with reduced ejection fraction (HFrEF) [4][5][6].…”