Association of Admission Glycaemia With High Grade Atrioventricular Block in ST-Segment Elevation Myocardial
Bi Huang1, Xinjie Wang, Yanmin Yang
1From the State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (BH, XW, YY, JZ, YL, HT, LY, XG, HZ, JW).
Insights
Elevated admission glycaemia (AG) above 10.05 mmol/L is linked to higher high-grade atrioventricular block (AVB) risk after ST-segment elevation myocardial infarction (STEMI), particularly in non-diabetic and newly diagnosed diabetic patients. This finding highlights AG as a potential risk indicator for AVB post-STEMI.
Area of Science:
- Cardiology
- Endocrinology
- Internal Medicine
Background:
- Elevated admission glycaemia (AG) is associated with arrhythmias post-myocardial infarction.
- The specific impact of elevated AG on high-grade atrioventricular block (AVB) after ST-segment elevation myocardial infarction (STEMI) requires further clarification.
Purpose of the Study:
- To investigate the association between elevated AG and the occurrence of high-grade AVB in patients with STEMI.
- To determine the optimal AG cutoff value for predicting high-grade AVB in STEMI patients.
Main Methods:
- A cohort of 3359 STEMI patients receiving reperfusion therapy was analyzed.
- Patients were categorized into non-diabetes mellitus (DM), newly diagnosed DM, and previously known DM groups.
- Receiver operating characteristic (ROC) curve analysis identified the optimal AG cutoff value (10.05 mmol/L) for predicting high-grade AVB.
Main Results:
- The prevalence of AG ≥ 10.05 mmol/L was 15.7% in non-DM, 34.1% in newly diagnosed DM, and 68.5% in known DM.
- High-grade AVB incidence was significantly higher in patients with AG ≥ 10.05 mmol/L compared to those with AG < 10.05 mmol/L in non-DM (5.7% vs. 2.1%) and newly diagnosed DM (10.2% vs. 1.4%).
- Multivariate analysis revealed AG ≥ 10.05 mmol/L as an independent predictor of high-grade AVB in non-DM (HR=1.826) and newly diagnosed DM (HR=5.252) patients. Both elevated AG and high-grade AVB were independent risk factors for 30-day all-cause mortality.
Conclusions:
- Elevated AG (≥ 10.05 mmol/L) is independently associated with an increased risk of high-grade AVB in STEMI patients, especially in non-diabetic and newly diagnosed diabetic individuals.
- Admission glycaemia level may serve as a valuable indicator for predicting high-grade AVB occurrence in STEMI patients.
Abstract:
Several studies have demonstrated the association between elevated admission glycaemia (AG) and the occurrence of some arrhythmias such as atrial fibrillation, ventricular tachycardia, and ventricular fibrillation after myocardial infarction. However, the impact of elevated AG on the high grade atrioventricular block (AVB) occurrence after ST-segment elevation myocardial infarction (STEMI) remains unclear. Included were 3359 consecutive patients with STEMI who received reperfusion therapy. The primary endpoint was the development of high grade AVB during hospital course. Patients were divided into non-diabetes mellitus (DM), newly diagnosed DM, and previously known DM according to the hemoglobin A1c level. The optimal AG value was determined by receiver operating characteristic curves analysis with AG predicting the high grade AVB occurrence. The best cut-off value of AG for predicting the high grade AVB occurrence was 10.05 mmol/L by ROC curve analysis. The prevalence of AG ≥ 10.05 mmol/L in non-DM, newly diagnosed DM, and previously known DM was 15.7%, 34.1%, and 68.5%, respectively. The incidence of high grade AVB was significantly higher in patients with AG ≥ 10.05 mmol/L than <10.05 mmol/L in non-DM (5.7% vs. 2.1%, P < 0.001) and in newly diagnosed DM (10.2% vs.1.4%, P < 0.001), but was comparable in previously known DM (3.6% vs. 0.0%, P = 0.062). After multivariate adjustment, AG ≥ 10.05 mmol/L was independently associated with increased risk of high grade AVB occurrence in non-DM (HR = 1.826, 95% CI 1.073-3.107, P = 0.027) and in newly diagnosed DM (HR = 5.252, 95% CI 1.890-14.597, P = 0.001). Moreover, both AG ≥ 10.05 mmol/L and high grade AVB were independent risk factors of 30-day all cause-mortality (HR = 1.362, 95% CI 1.006-1.844, P = 0.046 and HR = 2.122, 95% CI 1.154-3.903, P = 0.015, respectively). Our study suggested that elevated AG level (≥10.05 mmol/L) might be an indicator of increased risk of high grade AVB occurrence in patients with STEMI.
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