Association of Glycemic Gap with In-Hospital Adverse Outcome after First Attack of Acute ST Elevation Myocardial
M Ataullah1, M A Bari, M A S Bhuiyan
1Dr Mohammad Ataullah, Junior Consultant, Department of Cardiology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh;
Insights
An elevated glycemic gap in first-time ST-elevation myocardial infarction (STEMI) patients treated with thrombolysis is linked to worse in-hospital outcomes. This finding suggests glycemic gap can identify high-risk STEMI patients needing closer monitoring.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Medicine
Background:
- Stress-induced hyperglycemia (SIH), indicated by an elevated glycemic gap, is linked to adverse outcomes in acute coronary syndromes.
- Identifying reliable prognostic markers for ST-elevation myocardial infarction (STEMI) is crucial for patient management.
Purpose of the Study:
- To investigate the association between glycemic gap and in-hospital adverse outcomes in patients experiencing their first STEMI event.
- To determine if glycemic gap can serve as a prognostic marker in STEMI patients managed with thrombolysis.
Main Methods:
- A cross-sectional comparative study included 287 first-time STEMI patients treated with thrombolysis.
- Patients were categorized into two groups based on glycemic gap: >40 mg/dL (Group I) and ≤40 mg/dL (Group II).
- In-hospital complications and mortality were compared between the groups, with multivariate analysis performed.
Main Results:
- Group I patients exhibited significantly higher admission blood glucose and glycemic gap (p<0.001).
- Higher prevalence of hypertension, diabetes mellitus, and sedentary lifestyle was observed in Group I.
- In-hospital complications, including heart failure (60.2% vs. 28.3%), cardiogenic shock (35.16% vs. 17.75%), and mortality (13.28% vs. 5.66%), were significantly more common in Group I (p<0.05 for all).
- Elevated glycemic gap was an independent predictor of heart failure (OR=2.746; p=0.007).
Conclusions:
- A high glycemic gap is significantly associated with adverse in-hospital outcomes in first-time STEMI patients treated with thrombolysis.
- Glycemic gap may serve as a valuable prognostic marker for identifying high-risk STEMI individuals requiring intensified care.
Abstract:
Stress-induced hyperglycemia (SIH), reflected by an elevated glycemic gap, has been associated with poor outcomes in acute coronary syndromes. This study aimed to evaluate the association between glycemic gap and in-hospital adverse outcomes in patients experiencing their first attack of acute ST-elevation myocardial infarction (STEMI) who were managed with thrombolytic therapy. This cross-sectional comparative study was conducted at Mymensingh Medical College Hospital, Mymensingh, Bangladesh from October 2019 to March 2021. In this study 287 first-time STEMI patients were included who underwent thrombolysis. Total patients were divided into two groups based on glycemic gap: Group I (>40mg/dL) and Group II (≤40mg/dL). The mean age in Group I and Group II was 55.36±13.28 and 53.06±11.64 years respectively. Males predominated in both groups. Hypertension, diabetes mellitus and sedentary lifestyle were significantly more prevalent in Group I. Admission blood glucose and glycemic gap were significantly higher in Group I (p<0.001). In-hospital complications were significantly more common in Group I, including heart failure (60.2% vs. 28.3%, p<0.001), cardiogenic shock (35.16% vs. 17.75%, p<0.01) and mortality (13.28% vs. 5.66%, p<0.05). Multivariate analysis identified elevated glycemic gap as an independent predictor of heart failure (OR=2.746; 95% CI: 1.060-2.657; p=0.007). This study found that a high glycemic gap is significantly associated with adverse in-hospital outcomes in first-time STEMI patients treated with thrombolysis, suggesting it's potential as a useful prognostic marker for identifying high-risk individuals who require closer care.
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