Abstract
Acute hyperglycemia is a frequent finding in patients presenting to the emergency department (ED) with acute myocardial infarction (AMI). The prognostic role of hyperglycemia in diabetic patients with AMI remains controversial. We retrospectively reviewed patients’ medical records to obtain demographic data, clinical presentation, major adverse cardiac events (MACEs), several clinical scores and laboratory data, including the plasma glucose level at initial presentation and HbA1c levels. The glycemic gap, which represents changes in serum glucose levels during the index event, was calculated from the glucose level upon ED admission minus the HbA1c-derived average glucose (ADAG). We enrolled 331 patients after the review of medical records. An elevated glycemic gap between admission serum glucose levels and ADAG were associated with an increased risk of mortality in patients. The glycemic gap showed superior discriminative power regarding the development of MACEs when compared with the admission glucose level. The calculation of the glycemic gap may increase the discriminative powers of established clinical scoring systems in diabetic patients presenting to the ED with AMI. In conclusion, the glycemic gap could be used as an adjunct parameter to assess the severity and prognosis of diabetic patients presenting with AMI. However, the usefulness of the glycemic gap should be further explored in prospective longitudinal studies.
Highlights
Acute hyperglycemia is a frequent finding in patients presenting to the emergency department (ED) with acute myocardial infarction (AMI)
Consistent with previous studies, we found that Global Registry of Acute Coronary Events (GRACE) scores and the Killip classification showed a superior discriminative performance at predicting major adverse cardiac events (MACEs) in diabetic patients presenting to the ED with AMI
There were three major findings in the present study, as follows: 1) the glycemic gap, by eliminating the possible influences of chronic blood glucose controls, supports the possible deteriorating effects of Stress-induced hyperglycemia (SIH) on the early stage of AMI; 2) an elevated glycemic gap but not acute hyperglycemia was associated with increased mortality and the glycemic gap itself showed superior discriminative power for MACEs occurrence; and 3) the addition of the glycemic gap increased the discriminative power of the GRACE score in diabetic patients presenting to the ED with AMI
Summary
The admission blood glucose level after AMI is an independent predictor of long-term mortality in patients with or without diagnosed diabetes[1,2]. There are discordant findings on the correlation between hyperglycemia and adverse outcomes in acutely ill patients with or without preexisting diabetes[6,7,8]. In acutely ill diabetic patients, the epiphenomenon of admission hyperglycemia may be caused by acute physiological stress and/ or higher chronic baseline blood glucose levels[10]. We hypothesized that an elevated glycemic gap is associated with an increased risk of developing major adverse cardiac events (MACEs) in diabetic patients presenting to the ED with AMI. The aim of the present study was to explore the correlation between the glycemic gap and adverse clinical outcomes; in addition, we sought to justify the use of the glycemic gap as a biomarker for the severity of diabetic patients presenting to the ED with AMI
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