The association between glucose-related variables and plaque morphology in patients with ST-segment elevated myocardial infarction

Abstract

Background: Plaque rupture (PR) and plaque erosion (PE) are main causes of acute myocardial infarction with different demographic and histology characteristics and need different treatment strategy. PR and PE can be identified with optical coherence tomography (OCT) accurately, but convenient and effective noninvasive markers for them are rarely found. History of diabetes mellitus (DM) was reported to be a potential predictor of PR in ST-segment elevated myocardial infarction (STEMI) patients, but the predictive value of other glucose-related variables for it is still uncertain. Present study aimed to clear the relationship between some glucose-related variables and plaque morphology in patients with STEMI. Methods: We consecutively enrolled 872 STEMI patients and divided them into PR group (n = 616) and PE group (n = 256) based on OCT diagnostic criteria. The relationship of glucose-related variables, including random plasma glucose on admission (ARPG), glycosylated hemoglobin (HbA1c), post-PCI fasting plasma glucose (PFPG), DM history, glucose variable tendency (GVT) and the acute-to-chronic glycemic ratio (A/C), to the PR risk of STEMI patients was analyzed. The correlation between the glucose-related variables and plaque morphology was analyzed meanwhile. Results: Among the glucose-related variables, ARPG and GVT were confirmed to be independent predictors for PR after adjusting for other traditional risk factors in nondiabetic patients. The higher the ARPG level, the more PR risk the STEMI patients had. And high HbA1c and APPG were demonstrated to have a weak and positive correlation with lipid constituents and stenosis degree of culprit vessel. Conclusions: Compared to HbA1c, DM history, and some other glucose-related variables, ARPG and GVT were risk factors for PR in STEMI patients, especially those without DM. And high HbA1c and ARPG were positively correlated with the development of vulnerable plaque in culprit vessels. Trial registration Present study is a retrospective one and the population came from the EROSION study of our center previously. It was approved by the Ethics Committee of the Second Affiliated Hospital of Harbin Medical University (Approval reference number, KY2017-249), and all patients provided written informed consent prior to the inclusion in the study and the investigation conformed to the principles outlined in the Declaration of Helsinki.

Hyperglycemia, inflammatory response and infarct size in obstructive acute myocardial infarction and MINOCA

“…In fact, not only does hyperglycemia amplify the inflammatory cascade, but it is also promoted by the inflammatory process itself throughout the generation of insulin-resistance and gluconeogenesis [ 30 – 32 ]. As a result, the interplay between hyperglycemia and inflammation triggers a vicious circle, ultimately leading to a heightened atherosclerotic burden and plaque rupture [ 33 ] with an increased mortality risk [ 1 , 23 , 34 ].…”

Triglyceride glucose index combined with plaque characteristics as a novel biomarker for cardiovascular outcomes after percutaneous coronary intervention in ST-elevated myocardial infarction patients: an intravascular optical coherence tomography study

“…Insulin resistance at admission in participants with acute MI plays a key role in enhancing local platelet activation and thrombin generation [ 41 ] and is associated with a large thrombus burden, resulting in adverse cardiac outcomes [ 42 ]. Insulin resistance and glycaemic disorders, characterized by hyperglycaemia with hyperinsulinaemia or normoglycaemia, induce various pathophysiological abnormalities and are therefore accompanied by several cardiovascular and metabolic risk factors and comorbidities.…”

Plaque Erosion: A Distinctive Pathological Mechanism of Acute Coronary Syndrome

“…Liu et al studied the relationship between glucose-related variables and PR risk in STEMI patients [glucose-related variables included random plasma glucose on admission (ARPG), glycosylated hemoglobin (HbA1c), post-PCI fasting plasma glucose, acute-to-chronic glycemic ratio (A/C), glucose variable tendency (GVT), and DM history]. The results confirmed that ARPG and GVT are independent predictors for PR in non-diabetic patients; the higher the ARPG level, the greater the risk of PR in STEMI patients ( 67 ).…”