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Published on: May 28, 2019
Impact of glycemic control status on patients with ST-segment elevation myocardial infarction undergoing percutaneous
Yan Li1, Xiaowen Li2, Yinhua Zhang1
1Departent of Cardiology, Xuanwu hospital, Capital Medical University, Beijing, China.
Insights
Diabetes mellitus (DM) and blood glucose levels (APG, HbA1c) significantly impact long-term outcomes for ST-segment elevation myocardial infarction (STEMI) patients. Poor glycemic control in DM patients indicates a worse prognosis after primary percutaneous coronary intervention (pPCI).
Area of Science:
- Cardiology
- Endocrinology
- Clinical Medicine
Background:
- The combined predictive value of diabetes mellitus (DM), admission plasma glucose (APG), and glycated hemoglobin (HbA1c) for long-term outcomes in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI) remains unclear.
- Understanding these factors is crucial for risk stratification and management of STEMI patients.
Purpose of the Study:
- To evaluate the combined effects of DM status, APG, and HbA1c on predicting long-term clinical outcomes in STEMI patients treated with pPCI.
- To identify specific glycemic parameters and patient characteristics associated with adverse events.
Main Methods:
- A cohort of 350 consecutive STEMI patients undergoing pPCI was analyzed.
- Patients were stratified into groups based on DM history, APG, and HbA1c levels.
- Cumulative rates of 24-month all-cause death and major adverse cardiac and cerebrovascular events (MACCEs) were calculated.
Main Results:
- Patients without DM history and HbA1c < 6.5% had the lowest rates of all-cause death and MACCEs.
- DM patients with poor glycemic control or stress hyperglycemia exhibited the highest rates of all-cause death, MACCEs, and cardiac death.
- Admission HbA1c, APG, DM history, triglyceride levels, hemoglobin levels, and Killip class were significant predictors of 24-month all-cause death and MACCEs.
Conclusions:
- Combined assessment of DM, APG, and HbA1c provides significant prognostic information for STEMI patients undergoing pPCI.
- Poor glycemic control or stress hyperglycemia in DM patients is associated with a worse long-term prognosis.
- Strict glycemic control may be beneficial for patients with both DM and coronary heart disease.
Background:
The combined effects of diabetes mellitus (DM), admission plasma glucose (APG), and glycated hemoglobin (HbA1c) levels on predicting long-term clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) are unknown. Therefore, we evaluated their combined effects on long-term clinical outcomes in STEMI patients treated with pPCI.
Methods:
In total, 350 consecutive patients with STEMI undergoing pPCI were enrolled. Patients were divided into 3 groups according to DM history and APG and HbA1c levels. The cumulative rates of 24-month all-cause deaths and major adverse cardiac and cerebrovascular events (MACCEs) were calculated.
Results:
Both the incidence of all-cause deaths and cumulative rates of MACCEs were significantly the lowest in patients without a DM history and admission HbA1c level < 6.5%. DM patients with poor glycemic control or stress hyperglycemia on admission experienced the highest rates of all-cause deaths, MACCEs, and cardiac deaths. Admission HbA1c levels, Triglyceride (TG) levels, hemoglobin levels, DM history, and admission Killip class > 1 correlated with 24-month all-cause death; HbA1c levels on admission, DM history, APG levels, history of stroke, history of coronary heart disease, and TG levels on admission were significantly associated with MACCEs through the 24-month follow-up. The predictive effects of combining DM and APG and HbA1c levels were such that for STEMI patients undergoing pPCI, DM patients with poor glycemic control or with stress hyperglycemia on admission had worse prognosis than other patients.
Conclusion:
Strict control of glycemic status may improve the survival of patients who have both DM and coronary heart diseases.
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