Admission Plasma Glucose Level Research Articles

Association of admission plasma glucose level and cerebral computed tomographic perfusion deficit volumes

IntroductionHyperglycemia in acute ischemic stroke (AIS) is frequent and associated with worse outcome. Yet, strict glycemic control in AIS patients has failed to yield beneficial outcome. So far, the underlying pathophysiological mechanisms of admission hyperglycemia in AIS have remained not fully understood. We aimed to evaluate the yet equivocal association of hyperglycemia with computed tomographic perfusion (CTP) deficit volumes. Patients and methodsWe included 832 consecutive AIS and transient ischemic attack (TIA) patients who underwent CTP as a part of screening for recanalization treatment (stroke code) between 3/2018 and 10/2020, from the prospective cohort of Helsinki Stroke Quality Registry. Associations of admission glucose level (AGL) and CTP deficit volumes, namely ischemic core, defined as relative cerebral blood flow <30%, and hypoperfusion lesions Time-to-maximum (Tmax) >6 s and Tmax >10s, as determined with RAPID® software, were analyzed with a linear regression model adjusted for age, sex, C-reactive protein, and time from symptom onset to imaging. ResultsAGL median was 6.8 mmol/L (interquartile range 5.9–8.0 mmol/L), and 222 (27%) patients were hyperglycemic (glucose >7.8 mmol/L) on admission. In non-diabetic patients (643 [77%]), AGL was significantly associated with volume of Tmax.>6 s (regression coefficient [RC] 4.8, 95% confidence interval [CI] 0.49–9.1), of Tmax >10s (RC 4.6, 95% CI 1.2–8.1), and of ischemic core (RC 2.6, 95% CI 0.64–4.6). No significant associations were shown in diabetic patients. ConclusionAdmission hyperglycemia appears to be associated with both larger volume of hypoperfusion lesions and of ischemic core in non-diabetic stroke code patients with AIS and TIA.

Prognostic impact of plasma glucose on cardiogenic shock patients with or without diabetes ellitus: smart rescue trial

Abstract Background Even though the presence of hyperglycemia has shown to affect the clinical outcome of cardiogenic shock patients, the extent of hyperglycemia and its association with prognosis have not been fully addressed in large population Purpose Investigate the clinical relationship between hyperglycemic status and in-hospital mortality in cardiogenic shock patients Method A total of 1,177 consecutive cardiogenic shock patients were enrolled from January 2014 to December of 2018 at 12 hospitals in South Korea. The primary outcome was in-hospital mortality. Patients were divided into four groups according to their initial plasma glucose level in each of diabetes patients (n=752) and non-diabetes patients (n=425); group 1 (≤8 mmol/L), group 2 (8–12 mmol/L), group 3 (12–16 mmol/L) and group 4 (≥16 mmol/L). Results The groups with higher admission plasma glucose were associated with lower systolic blood pressure and higher lactic acid level in both diabetic and non-diabetic patients. In-hospital mortality increased in groups with higher admission plasma glucose level in non-diabetic patients (group-1:24.2%, group-2: 28.6%, group-3: 38.1%, group-4: 49.0%, p&amp;lt;0.01) whereas in diabetic patients, mortality and admission plasma glucose level showed no significant association (group-1: 45%, group-2: 35.4%, group-3: 33.3%, group-4: 43.1%, p=0.26). Even after Multivariate analysis, high plasma glucose was an independent predictor of in-hospital mortality in non-diabetic patients Conclusion In cardiogenic shock patients, plasma glucose obtained at admission was associated with in-hospital mortality in non-diabetic patients Funding Acknowledgement Type of funding sources: Private hospital(s). Main funding source(s): Inha University hospital

Association of Admission Glucose Level with Arrythmia and Heart Failure in Hyperglycemic Patients with Non-ST-Segment Elevation Myocardial Infarction

Background: Observetion of admission blood glucose level in non-ST elevation myocardial infarction is crucial to predict its outcome.Objective: To find out correlation of plasma glucose level with adverse events like arrythmia and heart failure in hyperglycemic patients with non-STsegment elevation myocardial infarction (NSTEMI).Methods: This prospective analytical study was conducted in the Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh, between June 2016 and May 2017. A total of 130 (95 males and 35 females) patients having NSTEMI participated in the study. Detail history was taken and physical examination was done. Venous blood samples were obtained from all patients to determine their cardiac troponins, plasma blood glucose, HbA1C, lipid profile, serum creatinine, and other cardiac enzymes. Then, the study participants were categorized into two groups. A total of 67 included (44 males and 23 females) in Group I, as having NSTEMI with plasma glucose level 7.8-9.3 mmol/l. In Group II, 63 were included (51 males and 12 females) having NSTEMI with plasma glucose level ≥9.4 mmol/l. Follow up was done according to the standard protocol,i.e. serial ECG, echocardiography, monitoring pulse, blood pressure, and auscultation of the lungs’ base.Results: The mean age of the patients was 49.68±3.12 years. Incidence of arrhythmia was observed in 4(5.97%) and 20(31.75%) cases in group I and group II respectively, while heart failure was found in 6(8.96%) and 48(76.19%) cases respectively (P&lt;0.001). A statistically significant moderate negative correlation with medium strength of association (r = -0.056) was observed between heart failure (as measured by LVEF and clinical status) and admission plasma glucose levels of the study participants suggesting that the higher was admission plasma glucose level (8.27±1.03 vs. 13.34±3.65; P&lt;0.001),the lower was the LVEF (54.19±7.13 vs. 44.21±7.36; P&lt;0.001), i.e. higher risks of heart failure. Conclusion: A higher admission plasma glucose level relates to a lower LVEF,i.e. higher incidence of arrythmia and heart failure in non ST-elevation MI patients.International Journal of Human and Health Sciences Vol. 06 No. 03 July’22 Page: 292-297

Prognostic Impact of Plasma Glucose on Patients With Cardiogenic Shock With or Without Diabetes Mellitus from the SMART RESCUE Trial

Although the presence of hyperglycemia has been shown to affect the clinical outcome of patients with cardiogenic shock, the extent of hyperglycemia and its association with prognosis have not been fully addressed in a large population. A total of 1,177 consecutive patients with cardiogenic shock were enrolled from January 2014 to December 2018 at 12 hospitals in South Korea. The primary outcome was in-hospital mortality. Patients were divided into 4 groups according to their initial plasma glucose level in patients with diabetes mellitus (DM) (n=752) and patients without DM (n=425); group 1 (≤8 mmol/L or 144 mg/100 ml), group 2 (8 to 12 mmol/L or 144 to 216 mg/100 ml), group 3 (12 to 16 mmol/L or 216 to 288 mg/100 ml), and group 4 (≥16 mmol/L or 288 mg/100 ml). The groups with higher admission plasma glucose were associated with lower systolic blood pressure and higher lactic acid levels in patients with and without DM. In-hospital mortality increased in groups with higher admission plasma glucose level in patients without DM (group 1:24.2%, group 2: 28.6%, group 3: 38.1%, group 4: 49.0%, p <0.01), whereas in patients with DM, mortality and admission plasma glucose level showed no significant association (group 1: 45%, group 2: 35.4%, group 3: 33.3%, group 4: 43.1%, p=0.26). Even after multivariate analysis, high plasma glucose was an independent predictor of in-hospital mortality in patients without DM. In patients with cardiogenic shock, plasma glucose obtained at admission was associated with in-hospital mortality in patients without DM.

IGF-1 is not related to long-term outcome in hyperglycemic acute coronary syndrome patients.

PurposeInsulin-like growth factor-1 (IGF-1) has been associated with both protective and detrimental effects on the development of ischemic heart disease. The relationship between IGF-1 levels and major adverse cardiovascular events (MACE) in acute coronary syndrome (ACS) patients remains unclear. This study aimed to investigate the relationship between IGF-1 admission levels in hyperglycemic ACS patients and: (1) MACE over a 5 years follow-up, (2) type 2 diabetes at discharge, and (3) post-ACS myocardial infarct size and dysfunction.MethodsThis was a post hoc analysis of the BIOMArCS-2 randomized controlled trial. From July 2008 to February 2012, 276 ACS patients with admission plasma glucose level between 140 and 288 mg/dL were included. Records of the composite of all-cause mortality and recurrent non-fatal myocardial infarction were obtained during 5 years follow-up. Venous blood samples were collected on admission. IGF-1 was measured batchwise after study completion. Oral glucose tolerance test was performed to diagnose type 2 diabetes, whereas infarct size and left ventricular function were assessed by myocardial perfusion scintigraphy (MPS) imaging, 6 weeks post-ACS.ResultsCumulative incidence of MACE was 24% at 5 years follow-up. IGF-1 was not independently associated with MACE (HR:1.00 (95%CI:0.99–1.00), p = 0.29). Seventy-eight patients (28%) had type 2 diabetes at discharge, and the highest quartile of IGF-1 levels was associated with the lowest incidence of diabetes (HR:0.40 (95%CI:0.17–0.95), p = 0.037). IGF-1 levels were not associated with post-ACS myocardial infarct size and dysfunction.ConclusionsIGF-1 carries potential for predicting type 2 diabetes, rather than long-term cardiovascular outcomes and post-ACS myocardial infarct size and dysfunction, in hyperglycemic ACS patients.

Development of a risk score for no-reflow phenomenon after percutaneous coronary interventions in patients with ST-segment elevation myocardial infarction

Background. No-reflow phenomenon during primary percutaneous coronary intervention (PCI) is a significant clinical problem in patients with ST-elevation myocardial infarction (STEMI), and its predictors remain unclear.Aim. To develop a scoring system to predict the risk of no-reflow in patients undergoing PCI for STEMI.Methods. Data were collected from 1280 consecutive patients with STEMI (59.2±11.4 years, 74.2% men, 5.2% no-reflow) who were admitted to the coronary care unit and underwent PCI. Baseline clinical, angiographic and procedural variables were used to develop the risk score in a training dataset (n=888, 70%) which was then validated in a test dataset (n=392, 30%). A credit risk assessment tool was used to construct a precise screening tool for no-reflow.Results. The model comprised age, pain to revascularisation time, neutrophil count, admission plasma glucose level, initial TIMI flow and direct stenting as the only independent predictors of no-reflow. These factors were weighted and used to develop a risk score ranging from 0 to 7. In the training dataset, the optimal threshold score for predicting no-reflow was ≥35, with 69% sensitivity and 81% specificity (area under the curve (AUC) = 0.84, p &lt; 0.001). When these findings were applied to the test dataset, the AUC was 0.75 (p &lt; 0.001), with 70% sensitivity and 80% specificity.Conclusion. The score developed in this study, based on clinical, angiographic and procedural features, can be used with acceptable accuracy to predict no-reflow in STEMI patients treated by PCI. Received 29 August 2019. Revised 25 March 2020. Accepted 16 April 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest.

Impact of glycemic control status on patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention

BackgroundThe 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.MethodsIn 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.ResultsBoth 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.ConclusionStrict control of glycemic status may improve the survival of patients who have both DM and coronary heart diseases.

P1438 the impact of on-admission hyperglycemia in patients with STEMI on the left ventricular function and 60 days mortality

Abstract Background Impaired on-admission glucose (AG) levels in patient with acute myocardial infarction is an often finding, even in the absence of diabetes mellitus (DM) within the patient past medical records. However, data regarding the relationship between hyperglycemia and LV function in STEMI are scarce. Furthermore it is unclear whether on-admission hyperglycemia tends to have any short to mid term-prognostic significance. Purpose The aim of this study was to determine the relationship of on-admission hyperglycemia on myocardial damage and evaluate the Short to mid term-prognostic significance of hyperglycemia in a high-risk STEMI population. Methods 234 Consecutive patients with STEMI who underwent primary percutaneous coronary intervention were prospectively selected. Plasma glucose level was measured on admission in all selected patients. Hyperglycemia was defined as admission plasma glucose level equal or more than 11.1 mmol/l. LV function was assessed by the measurement of EF using Simpson"s biplane method and by measurement of global longitudinal strain (GLS) using 2D speckle-tracking echocardiography (STE). The primary clinical end point was the occurrence of major adverse cardiovascular events at 60 days follow-up. Statistical analyses were performed using the SPSS 20.0 software. The value of p &amp;lt; 0,05 was considered as statistically significant. Results Patients were categorized on the basis of glucose level. 71 patients with high plasma glucose on admission were classified as a hyperglycemia group. Other 163 patients were assigned to a normoglycemia group. LV ejection fraction was significantly impaired within hyperglycemic group (44.9 ± 10,6% vs 50,4 ± 7,5%, p &amp;lt; 0.02), as well as, GLS was similarly impaired in hyperglycemia group (-12.9 ± 4.2% vs. -15.5 ± 3.4, p &amp;lt; 0.001). Occurrence of 60-days mortality was significantly higher in patients with hyperglycemia compared with normoglycemia group (10,3 % vs. 2%, p &amp;lt; 0.05). Multivariable linear regression analysis revealed admission glucose level is independently associated with LV GLS (B = 0.08, 96 % CI 0.04 - 0.17, p &amp;lt; 0.01). In multivariable logistic regression analysis was showed that admission glucose level is independently associated with 60-days mortality after adjustment of clinical variables (OR 1.10, 95% CI 1.01 - 1.25, p &amp;lt; 0.05). Conclusion Our Study reveals that on-admission hyperglycemia is strong and independent predictor of left ventricular function and 60 days mortality in patients with ST-elevation myocardial infarction . Abstract P1438 Figure.

FREQUENCY OF STRESS HYPERGLYCEMIA AMONG PATIENTS WITH ACUTE LEFT VENTRICULAR FAILURE

Objective: To determine the frequency of stress hyperglycemia among patientswith acute left ventricular failure. Methodology: This cross-sectional study was conducted in the in thedepartment of cardiology, Hayatabad Medical Complex, Peshawar fromSeptember 2013-August 2014. Patients presenting acute left ventricular failurewere included in the study in a consecutive manner and subjected tomeasurement of blood glucose level and observations were recorded data wasanalysis on SPSS 22 with p<0.05 taken as significant. Results: In this study 171 patients were included, 60.2% were male. Mean ageof the patients was 58.7 ±7.9 years. Most of the patients (71.4%) were between50.01 to 70.00 years. Of the whole sample, 46.8% were hypertensive, 39.8% hadhistory of coronary artery disease and 53.8% were having BMI beyond 22.9.Mean admission plasma glucose level of the sample was 133+24.1mg/dl with33.3% patients having stress hyperglycemia. Conclusion: Stress hyperglycemia is frequent occurrence in our population withleft ventricular failure.

Elevated Glycemic Gap Predicts Acute Respiratory Failure and In-hospital Mortality in Acute Heart Failure Patients with Diabetes

Diabetes is a common comorbidity in patients hospitalized for acute heart failure (AHF), but the relationship between admission glucose level, glycemic gap, and in-hospital mortality in patients with both conditions has not been investigated thoroughly. Clinical data for admission glucose, glycemic gap and in-hospital death in 425 diabetic patients hospitalized because of AHF were collected retrospectively. Glycemic gap was calculated as the A1c-derived average glucose subtracted from the admission plasma glucose level. Receiver operating characteristic (ROC) curves were used to determine the optimal cutoff value for glycemic gap to predict all-cause mortality. Patients with glycemic gap levels >43 mg/dL had higher rates of all-cause death (adjusted hazard ratio, 7.225, 95% confidence interval, 1.355–38.520) than those with glycemic gap levels ≤43 mg/dL. The B-type natriuretic peptide levels incorporated with glycemic gap could increase the predictive capacity for in-hospital mortality and increase the area under the ROC from 0.764 to 0.805 (net reclassification improvement = 9.9%, p < 0.05). In conclusion, glycemic gap may be considered a useful parameter for predicting the disease severity and prognosis of patients with diabetes hospitalized for AHF.

Admission plasma glucose and maternal prognostic factors in preeclampsia

Aims: We aimed to investigate if admission plasma glucose (PG) level was a significant and independent risk factor for the patients' length of stay at the intensive care unit (ICU), as the primary outcome parameter, and also for the maternal and fetal complications, as the secondary outcome parameters, among a group of nondiabetic pregnant women with severe preeclampsia. Materials and Methods: In this prospective case–control study including 63 pregnant women, admission PG, glycosylated hemoglobin, neutrophil–lymphocyte ratio, platelet count, liver enzymes, and other laboratory parameters and clinical characteristics including length of stay at the hospital, maternal, and fetal complications were investigated. Results: Admission PG levels were found to be significantly elevated in preeclamptic women with poor outcome. Furthermore, platelet count, fibrinogen, alanine aminotransferase, and aspartate aminotransferase values were significantly associated with the length of stay at ICU. Conclusion: We claimed that hyperglycemia was an acute reaction, reflecting the severity of preeclampsia and PG levels to be added to the routine high-risk pregnancy panel on initial presentation to the hospital.

Role of plasma glucose level on myocardial perfusion in ST-segment elevation myocardial infarction patients

AimsHyperglycemia is frequent in patients with ST elevation myocardial infarction (STEMI) and is associated with adverse outcome. Aim of our study was to evaluate the correlation between admission plasma glucose level (PGL) and coronary arteries flow velocity. MethodsWe enrolled 149 STEMI patients successfully treated with primary percutaneous coronary intervention (pPCI). The study population was divided into two groups based on PGL (< or >140 mg/dl) and on history of diabetes, and the groups compared in terms of corrected TIMI frame count (cTFC). ResultsHyperglycemic patients had a significantly higher cTFC in both the culprit (p < 0.0001) and non-culprit vessel (p: 0.0002); diabetes history impairs as well cTFC of the culprit (p < 0.0001) and non-culprit vessel (p: 0.0001). Within the subpopulation of diabetic patients hyperglycemic ones showed higher cTFC in both the culprit (p 0.0013) and non-culprit vessel (p: 0.0006). Moreover in the whole population cTFC values of both arteries increase linearly with the increment of admission PGL. ConclusionsAdmission PGL affects coronary flow of both culprit and non-culprit vessel. The impairment of coronary flow is also demonstrated in known diabetic patients, suggesting to consider hyperglycemia an additional risk factor. We finally demonstrated for the first time a positive linear relationship between PGL and cTFC.

Admission hyperglycemia and adverse outcomes in diabetic and non-diabetic patients with non-ST-elevation myocardial infarction undergoing percutaneous coronary intervention

BackgroundThe association between admission hyperglycemia and adverse outcomes in patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI) has not been well studied, and the optimal plasma glucose cut-off values for prognosis for NSTEMI patients with and without diabetes have not been determined.MethodsAccording to glucose level and diabetes status, consecutive NSTEMI patients undergoing PCI (n = 890) were divided into four groups: without diabetes mellitus (DM) and admission plasma glucose (APG) <144 or ≥144 mg/dL; or with DM and APG <180 or ≥180 mg/dL. All patients were followed up at 30 days and 3 years after discharge, and the outcomes were assessed.ResultsAdmission hyperglycemia was found in 44 and 28% of the DM and non-DM patients, respectively. Multivariable analyses showed that the APG level was an independent predictor of 30-day and 3-year MACEs. Receiver operating characteristic curve analysis revealed that the appropriate cut-off values were 178 and 145 mg/dL for patients with and without DM, respectively, or 157 mg/dL for all patients.ConclusionsAdmission hyperglycemia may be used to predict 30-day and 3-year MACEs in patients with NSTEMI undergoing PCI, irrespective of diabetes status. However, the optimal admission glucose cut-off values for predicting prognosis differ for patients with or without DM.

Admission plasma glucose levels within the normal to mildly impaired range and the outcome of patients with acute coronary syndrome.

Elevated admission plasma glucose levels >140 mg/dl are associated with adverse clinical outcomes in both diabetic and non-diabetic patients admitted with acute coronary syndrome (ACS). We aimed to evaluate the association between admission plasma glucose levels <140 mg/dl and the outcome of non-diabetic patients admitted with acute coronary syndrome. The study population consisted of patients with acute coronary syndrome included in the Acute Coronary Syndrome Israeli Survey during 2000-2013. Diabetic patients were excluded. The primary endpoint was all-cause mortality at one year. The 452 0 patients had a mean age of 61.7±13.5 years and were stratified into four quartiles according to admission plasma glucose (60-94, 95-105, 106-119, 120-140 mg/dl). Patients with higher admission plasma glucose were older and included a higher percentage of smokers. In addition, the higher the glucose so also did they have a poorer risk factor profile including a higher body mass index, total and low-density lipoprotein cholesterol and triglyceride levels, and lower high-density lipoprotein cholesterol levels. During the first year 5.2% of patients died. A comparison of one-year mortality according to admission plasma glucose quartiles demonstrated a significant and progressive increase in mortality risk as admission plasma glucose rose (3.5%, 4.1%, 6.1%, 6.4%, respectively, p=0.001). However, this association lost its clinical significance following a multivariate analysis ( p=0.08). High admission plasma glucose levels within the normal to mildly impaired range are associated with increased one-year mortality in non-diabetic acute coronary syndrome patients. However, the higher glucose level is probably not the cause for the adverse outcome but rather a marker for high risk. Our findings support the definition of 140 mg/dl as the cutoff for clinically acceptable admission glucose levels in patients with acute coronary syndrome.

A risk score for no reflow in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention.

Many factors are associated with no-reflow (NRF) phenomenon in ST-segment elevation myocardial infarction (STEMI), including plasma glucose, age, and pre-percutaneous coronary intervention (PCI) thrombus score. Initial clinical assessment would benefit from accurate NRF prediction. This study aimed to develop a simple scoring system to predict the risk of NRF in patients undergoing primary PCI with STEMI. Baseline clinical and procedural variables were used for risk score development (the training dataset, n = 912) and validation (the test dataset, n = 864). Independent predictors of NRF from the multivariable model were assigned integer weights based on their coefficients and incorporated into a risk score. The discriminant ability of the score was tested by receiver operating characteristic analysis using the test dataset. The final model included 7 significant variables, which were age, pain-to-PCI time, neutrophil count, admission plasma glucose level, pre-PCI thrombus score, collateral circulation, and Killip class. All these variables were then used to build a risk score in terms of the prediction of NRF. Receiver operating characteristic analysis demonstrated good risk prediction with a c statistic of 0.800 (95% confidence interval: 0.772-0.826) in the test dataset. In patients with STEMI treated by primary PCI, incidence of NRF phenomenon may be predicted with an acceptable accuracy based on a 7-item simplified risk score.

Impact of HbA1c on Outcomes of Acute Coronary Syndrome in Non-Diabetic Patients

Background : Elevated glucose levels have been previously shown to be associated with adverse outcomes in patients of acute coronary syndrome. However, admission glucose levels are affected by various factors like meals, circadian cycle and also the stress response. HbA1c is a better marker of long- term glucose status. The value of HbA1c as a predictor of prognosis in acute coronary syndrome has not been extensively studied. Objective : To study the relationship between admission HbA1c levels and short-term outcome in non-diabetic patients admitted with acute coronary syndrome. Material and Methods : This open-label, hospital based, cohort study was conducted on 200 patients without previously known diabetes admitted with acute coronary syndrome. A detailed history and clinical examination were carried out. Admission plasma glucose, fasting glucose and HbA1c levels were recorded. Those presenting with fasting plasma glucose of >126 mg% or HbA1c >6.5% were labeled as “Undiagnosed Diabetic Patients”. Outcome was measured mainly by assessing the left ventricular systolic function. Data were analysed using chi square test, student t-test, ANOVA and partial correlation regression, wherever applicable. Results : Mean age of patients was 56.38 years. Average BMI was 25.1±3.5 kg/m2. Mean HbA1c was 6.3±1.5%. 79 (39.5%) patients had HbA1c between 6 and 6.5. There was a linear correlation between ejection fraction and HbA1c (p value =0.019). Conclusion : HbA1c is a strong predictor of left ventricular dysfunction in non-diabetic patients presenting with acute coronary syndrome, therefore, measurement of HbA1c levels may improve risk assessment in patients presenting with acute coronary syndrome.

Can Admission Neutrophil to Lymphocyte Ratio Predict Infarct-Related Artery Patency in ST-Segment Elevation Myocardial Infarction

In this study, we aimed to investigate the relationship between neutrophil to lymphocyte ratio (NLR) and infarct-related artery (IRA) patency in patients with ST-segment elevation myocardial infarction (STEMI). A total of 349 patients with STEMI were recruited to this retrospective study. Baseline characteristics were reviewed. Patency of IRA was evaluated by thrombolysis in myocardial infarction flow grade. Of all patients, 293 patients formed the occluded IRA group and 56 patients formed the patent IRA group. The NLR was significantly higher in occluded IRA group (4.4 ± 4.1 vs 1.9 ± 1.1, P < .001). Glucose levels were also higher in occluded IRA group (171.3 ± 78.0 vs 144.7 ± 49.7, P = .022). Regression analysis demonstrated admission NLR and plasma glucose levels as independent predictors of IRA patency. In this study, we found that admission NLR and glucose levels were higher in patients with occluded IRA than in patients with STEMI. We also found that NLR and glucose levels were independent predictors of IRA patency. Because hemogram is a cheap, fast, and widely available test, it can be used in daily practice as a predictor of IRA patency.

High admission glucose levels increase Fas apoptosis and mortality in patients with acute ST-elevation myocardial infarction: a prospective cohort study

BackgroundThe presence of diabetes and plasma glucose concentration on admission are associated with adverse outcomes after an acute myocardial infarction (AMI), as high glucose can induce vascular endothelial cell apoptosis. This study explored the relative associations among admission plasma glucose level, soluble Fas (sFas) concentration, and long-term survival in patients with acute ST-elevation myocardial infarction (STEMI).MethodsThis prospective cohort study include 83 patients with acute STEMI. Based on their admission plasma glucose levels (7.8 and 11.1 mmol/L as the limits for low and high levels, respectively), patients were allocated into one of three groups: normal glucose (n = 33), median glucose (n = 24), and high glucose (n = 26). The admission plasma level of sFas was measured with a sandwich enzyme-linked immunosorbent assay (ELISA). Patients were followed up for an average of 89 ± 20 months for all causes of death and cardiovascular death.ResultssFas levels were significantly higher in the high glucose group compared to the normal glucose group (5.87 ± 1.70 mmol/L vs. 3.07 ± 0.93 mmol/L, respectively, P < 0.05). The sFas level was positively associated with the admission plasma glucose level. The correlation coefficient (R) was 0.747, and R2 was 0.559. Mortality was significantly higher in the high glucose group compared to the normal glucose group (19.2% vs. 3.0%, respectively, P < 0.05).ConclusionsIn patients with acute STEMI, plasma glucose level was high on admission, and sFas apoptosis levels were increased. Long-term follow-up revealed that a high admission plasma glucose level was associated with higher mortality compared to a normal admission glucose level.

Intensive Glucose Regulation in Hyperglycemic Acute Coronary Syndrome

Elevated plasma glucose levels in patients with acute coronary syndrome (ACS) on hospital admission are associated with increased mortality. Clinical trials of glucose regulation have provided inconsistent results with respect to cardiovascular outcomes, perhaps because target glucose levels have been suboptimal. To study the effectiveness and safety of intensive glucose management in patients with ACS who have hyperglycemia, aiming at strict blood glucose normalization. Single-center, prospective, open-label, randomized clinical trial in a large teaching hospital. Patients with ACS with an admission plasma glucose level of 140 to 288 mg/dL were eligible for inclusion and enrolled from July 23, 2008, to February 8, 2012. Patients with insulin-dependent diabetes mellitus were excluded. Informed consent was obtained from 294 patients, who were randomized. Of these, 93.6% received percutaneous coronary intervention (PCI). Intensive glucose management strategy, aiming at a plasma glucose level of 85 to 110 mg/dL by using intravenous insulin, or to conventional expectative glucose management. End points were assessed according to the intention-to-treat principle. The primary end point was high-sensitivity troponin T value 72 hours after admission (hsTropT72); secondary end points, area under the curve of creatine kinase, myocardial band (AUC-CK-MB), release and myocardial perfusion scintigraphy findings at 6 weeks' follow-up. In the intensive management arm, median hsTropT72 was 1197 ng/L (25th and 75th percentiles of distribution, 541-2296 ng/L) vs 1354 ng/L (530-3057 ng/L) in the conventional arm (P = .41). Median AUC-CK-MB was 2372 U/L (1242-5004 U/L) vs 3171 U/L (1620-5337 U/L) (P = .18). The difference in median extent of myocardial injury measured by myocardial perfusion scintigraphy was not significant (2% vs 4%) (P = .07). Severe hypoglycemia (<50 mg/dL) was rare and occurred in 13 patients. Before discharge, death or a spontaneous second myocardial infarction occurred in 8 patients (5.7%) vs 1 (0.7%) (P = .04). CONCLUSIONS AND RELEVANCE Intensive glucose regulation did not reduce infarct size in hyperglycemic patients with ACS treated with PCI, and was associated with harm. Future studies should focus on patients with ACS who have persistently elevated blood glucose after PCI, and should evaluate alternative strategies for optimizing glycemia. www.trialregister.nl Identifier: NTR1205.

Admission hyperglycemia in acute myocardial infarction

The aim of this study was to investigate the relationship between admission plasma glucose levels and abnormal glucose metabolism in patients with acute myocardial infarction (AMI) without a previous diagnosis of diabetes mellitus. A total of 285 nondiabetic patients admitted with AMI were screened for glucometabolic disorders by using fasting glucose measurements during hospital stay or an oral glucose tolerance test on discharge. Patients diagnosed as having diabetes mellitus were followed-up for a mean of 60 ± 33 months in order to confirm the diagnosis. There was a graded relationship between admission glucose levels and the prevalence of newly detected diabetes mellitus (group 1, <140 mg/dl: 12%; group 2, ≥140 < 200 mg/dl: 40%; group 3, ≥200 mg/dl: 70.3%; P < 0.0001). The admission glucose level of at least 144 mg/dl was the best predictor of newly detected diabetes mellitus during hospitalization (area under the curve 0.78, P = 0.0001). In multivariable analysis, patients with admission hyperglycemia had greater odds of having newly detected diabetes mellitus (odds ratio 6.6, 95% confidence interval 2.7-16.3, P = 0.0001). Diabetes mellitus was confirmed in the long-term follow-up in 78% of patients diagnosed as having diabetes mellitus during hospitalization. Our finding suggests a relationship between admission glucose and previously undetected diabetes mellitus in nondiabetic patients presenting AMI. Acute hyperglycemia may help to identify high-risk patients for diabetes mellitus, who should be screened initially for glucometabolic disorders, then closely monitored and appropriately treated to improve outcome.