Prognostic value of glycemic gap in ST-segment elevation myocardial infarction-associated acute kidney injury

Area of Science:

• Cardiology
• Nephrology
• Endocrinology

Background:

• Stress-induced hyperglycemia (SIH) is common in acute myocardial infarction (AMI) and linked to poor outcomes.
• The association between glycemic gap (GG), a marker of SIH, and ST-segment elevation myocardial infarction (STEMI)-associated acute kidney injury (STAAKI) is not well-defined.
• Understanding predictors of STAAKI is crucial for managing STEMI patients post-percutaneous coronary intervention (PCI).

Purpose of the Study:

• To investigate the predictive value of GG for STAAKI risk in STEMI patients undergoing primary PCI.
• To determine if GG can enhance the accuracy of existing risk models for STAAKI.
• To explore the relationship between GG and STAAKI occurrence.

Main Methods:

• Retrospective analysis of STEMI patients who underwent primary PCI.
• Logistic regression to identify independent risk factors for STAAKI.
• Restricted cubic splines (RCS) to assess the dose-response relationship between GG and STAAKI.
• Evaluation of model predictive accuracy using Delong test, NRI, and IDI.

Main Results:

• The study included 595 patients; STAAKI incidence was 9.2%.
• Independent predictors of STAAKI included LVEF, NT-proBNP, and GG (OR per 1 mmol/L increase = 1.379).
• RCS analysis revealed a linear dose-response relationship between GG and STAAKI.
• Integrating GG into the risk model significantly improved its predictive accuracy (NRI = 0.780, IDI = 0.095).

Conclusions:

• Glycemic gap (GG) is an independent risk factor for STAAKI in STEMI patients post-PCI.
• Incorporating GG into risk assessment models substantially enhances the prediction of STAAKI.
• GG serves as a valuable biomarker for identifying STEMI patients at higher risk of developing acute kidney injury.