Effect of glycemic variability on short term prognosis in acute myocardial infarction subjects undergoing primary
Jian-Wei Zhang1, Ling-Jie He2, Shu-Jun Cao3
1Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing 100029, China.
Insights
Glycemic variability (GV) is a significant predictor of adverse cardiac events in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (p-PCI). Higher GV, particularly in diabetic patients, indicates a worse prognosis and increased risk of major adverse cardiac events.
Area of Science:
- Cardiology
- Endocrinology
- Medical Diagnostics
Background:
- Glycemic variability (GV) is increasingly recognized as a critical factor in cardiovascular outcomes.
- The prognostic significance of acute glycemic excursions in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (p-PCI) remains incompletely understood.
Purpose of the Study:
- To evaluate the prognostic value of GV in STEMI patients treated with p-PCI.
- To determine if acute glycemic excursions impact the prognosis of STEMI patients undergoing p-PCI.
Main Methods:
- A study of 237 STEMI patients undergoing p-PCI, collecting clinical and laboratory data.
- Continuous glucose monitoring system (CGMS) used to measure blood glucose fluctuations.
- Patients grouped by diabetes status and tertiles of mean amplitude of glycemic excursions (MAGE); major adverse cardiac events (MACE) documented during follow-up.
Main Results:
- Higher MAGE levels correlated with elevated peak CK-MB and cTnI values.
- Composite MACE rates increased with higher MAGE tertiles (7.5% vs. 14.1% vs. 22.8%, P=0.025).
- Diabetic patients with higher MAGE showed significantly higher MACE and non-IRA revascularization rates; GV emerged as an independent predictor of MACE in both diabetic and non-diabetic STEMI patients.
Conclusions:
- Increased GV is linked to composite MACE and non-IRA revascularization in STEMI patients post-p-PCI, especially in diabetic individuals.
- GV independently predicts MACE in STEMI patients undergoing p-PCI, highlighting its prognostic importance.
- The findings underscore the need to monitor and manage GV in STEMI patients to improve outcomes.
Objective:
Glycemic 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.
Methods:
We 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.
Results:
Data 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.
Conclusions:
Greater 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.
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