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A meta-analysis on the correlation between admission hyperglycemia and myocardial infarct size on CMRI
Stella Pak1, Yan Yatsynovich1, John-Phillip Markovic1
1Department of Medicine, Kettering Medical Center, Kettering, OH, 45429, USA.
Aims:
The aim was to compare the size of the myocardial infarct detected on cardiovascular magnetic resonance imaging (CMR) between patients with and without admission hyperglycemia after acute myocardial infarction (AMI).
Methods:
Studies were identified by searching on MEDLINE, EMBASE, and CINAHL databases. A systematic review was conducted by two independent reviewers. Microvascular obstruction (MVO) and late gadolinium enhancement (LGE) were pooled from available studies to calculate the standardized mean difference (SMD) in post-MI infarct size between patients with and without hyperglycemia at admission.
Results:
The systematic review yielded 5 studies with MCR data for patients with and without admission hyperglycemia. The total number of patients included in this study was 911. A statistically significant difference was detected in MVO between patients with and without admission hyperglycemia (SMD = 0.79, 95% CI: 0.11, 1.47, P < 0.00001). The difference in LGE between patients with and without admission hyperglycemia was also significant (SMD = 0.57, 95% CI: -0.04, 1.18, P < 0.00001).
Conclusion:
The main finding of our analyses is that the size of myocardial infarct detected on CMR is positively correlated to admission hyperglycemia in patients with AMI. The clinical importance of this study lies in the accurate assessment of prognostic value of admission glucose, which would help clinicians in risk stratification and treatment decision-making.
Insights
Admission hyperglycemia, a condition of high blood sugar upon hospital arrival, is linked to larger myocardial infarct sizes in acute myocardial infarction (AMI) patients. This finding aids in risk stratification and treatment decisions.
Area of Science:
- Cardiology
- Medical Imaging
- Metabolic Disorders
Background:
- Acute myocardial infarction (AMI) is a leading cause of cardiovascular mortality.
- Admission hyperglycemia is a common finding in AMI patients and is associated with adverse outcomes.
- Cardiovascular magnetic resonance imaging (CMR) is a key tool for assessing myocardial infarct size.
Purpose of the Study:
- To compare myocardial infarct size, as assessed by CMR, between patients with and without admission hyperglycemia after AMI.
- To evaluate the association between admission hyperglycemia and infarct characteristics like microvascular obstruction (MVO) and late gadolinium enhancement (LGE).
Main Methods:
- A systematic review of studies was conducted using MEDLINE, EMBASE, and CINAHL databases.
- Two independent reviewers extracted data on MVO and LGE from 5 studies, including 911 patients.
- Standardized mean differences (SMD) were calculated to compare infarct size between hyperglycemic and normoglycemic groups.
Main Results:
- A statistically significant increase in MVO was observed in patients with admission hyperglycemia (SMD = 0.79, P < 0.00001).
- Late gadolinium enhancement (LGE), indicative of infarct scar size, was also significantly larger in patients with admission hyperglycemia (SMD = 0.57, P < 0.00001).
Conclusions:
- Admission hyperglycemia is positively correlated with larger myocardial infarct size detected by CMR in AMI patients.
- These findings highlight the prognostic value of admission glucose levels for risk stratification and guiding treatment decisions in AMI management.