Abstract
ObjectiveGlycemic variability (GV) still remains unclear whether acute glycemic excursion has the important prognostic significance in ST-segment elevation myocardial infarction (STEMI) patients undergoing p-PCI. So our aim is to assess the prognostic value of GV in STEMI patients undergoing p-PCI.MethodsWe studied 237 STEMI patients undergoing p-PCI, whose clinical and laboratory data were collected. We used a continuous glucose monitoring system (CGMS) to measure the fluctuations of blood glucose. Participants were grouped into diabetes group and non-diabetes group, and grouped into tertiles of mean amplitude of glycemic excursions (MAGE). The major adverse cardiac events (MACE) of patients was documented during in-hospital and 30-day follow-up. The relationship of MAGE and the incidence of MACE were analyzed.ResultsData from 237 subjects were incorporated into the statistical analysis, a higher MAGE level was associated with the higher peak CK-MB values (r = 0.374, P <0.01), and the higher peak cTnI values (r = 0.410, P <0.01). The rate of composite MACE by MAGE tertiles (<2.37 mmol/l, 2.37-3.65 mmol/l and >3.65 mmol/l) was 7.5% vs. 14.1% vs. 22.8%, respectively (P = 0.025); STEMI patients with a higher MAGE level had a significantly higher non-IRA revascularization compared with those with lower MAGE levels (32% vs. 15% vs. 21%, P = 0.037). Moreover, diabetic patients with higher MAGE level had significantly higher incidence of composite MACE and non-IRA revascularization, non-diabetic subjects did not show the similar results. In multivariable logistic analysis, the independent predictors of MACE were: MBG, MAGE and LVEF in diabetic subjects and were MBG and MAGE in nondiabetic subjects. Other factors were not significantly associated with MACE.ConclusionsGreater GV is associated with composite MACE and non-IRA revascularization during in-hospital and 30-day follow-up in unadjusted analyses, especially for diabetic subjects. After multivariable logistic analysis, GV remains an independent prognostic factor for composite MACE in STEMI patients undergoing p-PCI.
Highlights
Hyperglycemia is common during acute myocardial infarction (AMI)
Based on the inclusion criteria and the exclusion criteria, we enrolled 247 segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary interventions (p-PCI), 10 cases were excluded for final analysis due to the Continuous glucose monitoring systems (CGMS) signal interruption or not meeting the accuracy requirements
The reanalysis of the Diabetes Control and Complications Trial (DCCT) and DCCT/Epidemiology of Diabetes Interventions and Complications (EDIC) dataset examining the predictive value of glycemic variability (GV) on microvascular and neurologic complications did not show an effect of GV independent from mean glucose and HbA1c [21,22,23]
Summary
Hyperglycemia is common during acute myocardial infarction (AMI). It is a strong predictor of mortality in AMI patients with and without a history of diabetes mellitus [1,2]. Continuous glucose monitoring systems (CGMS) could provide detailed time series of consecutive observations on the underlying process of glucose fluctuations. Such detailed glucose information to patients has been shown to have positive influence on glucose control, including reduction in glucose variability, time spent in nocturnal hypoglycemia, time spent in hyperglycemia, and levels of glycosylated hemoglobin [11,12,13]. GV still remains unclear whether acute glycemic excursion has the important prognostic significance in AMI patients
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