Myocardial Infarction In Diabetic Patients Research Articles

Effect of SGLT2 Inhibitors on Post-PCI Outcomes after Acute Myocardial Infarction in Diabetic Patients: A Systematic Review and Meta-Analysis

Background: Acute myocardial infarction (AMI) is related with poor outcomes in patients with diabetes mellitus (DM). Whether diabetic patients with AMI undergoing percutaneous coronary intervention (PCI) benefit from sodium–glucose cotransporter 2 inhibitors (SGLT2i) in terms of cardiovascular mortality, myocardial damage, and left ventricular function is unclear. Methods: Through a comprehensive search in PubMed, EMBASE, and Web of science databases from January 2018 to September 2023, randomized controlled trials were performed to compare SGLT2i with other oral antidiabetic medications in diabetic patients with AMI undergoing PCI. Cardiovascular mortality constituted the primary outcome. Secondary outcomes were high-sensitivity troponin I (hs-TnI) levels, left ventricular ejection fraction (LVEF), and contrast-induced acute kidney injury (CI-AKI). Results: SGLT2i significantly reduced cardiovascular mortality risk versus other antidiabetic agents (hazard ratio (HR): 0.35, 95% confidence interval (CI): 0.21–0.58, p < 0.0001). SGLT2i also lowered hs-TnI levels across all time points (mean difference: –2931 ng/L, p < 0.001). After adjustment for publication bias, this difference was no longer significant. However, peak hs-TnI levels remained significantly lower with SGLT2i (mean difference: –3836 ng/L, p < 0.001). Finally, SGLT2i improved LVEF versus comparators, with a mean difference of –5.00% (95% CI: –6.69 to –3.31, p < 0.001) at hospital discharge. SGLT2i was also associated with 60% lower odds of CI-AKI (odds ratio (OR): 0.40, 95% CI: 0.22–0.75, p = 0.004). Conclusions: Compared with other antidiabetic medications, SGLT2i may lower cardiovascular mortality, infarct size, and prevent left ventricle (LV) systolic dysfunction in diabetic patients with AMI undergoing PCI. The use of SGLT2i in this high-risk group is supported by these findings.

Application of target trail emulation in real world: a case study of effect of statins on mortality in diabetes patients

Target trail emulation is an observational research method, which can use real-world data (such as observational data and historical data) to carry out research design according to the design principles of randomized controlled trials (RCT) when RCT cannot be carried out. The intervention group and the control group were classified by simulating random grouping. Finally a high-reliable conclusion similar to RCT can be obtained. This paper summarizes the basic concepts and application process of target trail emulation based on the effect of statins on the prognosis of myocardial infarction in diabetic patients to provide reference for the application of this method in real world.

Identification of key proteins as potential biomarkers associated with post-infarction complications in diabetics.

Background: The ability of transcriptome analysis to identify dysregulated pathways and outcome-related genes following myocardial infarction in diabetic patients remains unknown. The present study was designed to detect possible biomarkers associated with the incidence of post-infarction complications in diabetes to assist thedevelopment of novel treatments for this condition.Methods: Two gene expression datasets, GSE12639 and GSE6880, were downloaded from the Gene Expression Omnibus (GEO) database, and then differentially expressed genes (DEGs) were identified between post-infarction diabetics and healthy samples from the left ventricular wall of rats. These DEGs were then arranged into a protein-protein interaction (PPI) network, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway and Gene Ontology (GO) enrichment analyses were performed to explore the functional roles of these genes.Results: In total, 30 DEGs (14 upregulated and 16 downregulated) were shared between these two datasets, as identified through Venn diagram analyses. GO analyses revealed these DEGs to be significantly enriched in ovarian steroidogenesis, fatty acid elongation, biosynthesis of unsaturated fatty acids, synthesis and degradation of ketone bodies, and butanoate metabolism. The PPI network of the DEGs had 14 genes and 70 edges. We identified two key proteins, 3-hydroxymethylglutaryl-CoA synthase 2 (Hmgcs2) and Δ3, Δ2-Enoyl-CoA Delta Isomerase 1 (ECI1), and the upregulated gene Hmgcs2 with the highest score in the MCC method. We generated a co-expression network for the hub genes and obtained the top ten medications suggested for infarction with diabetes.Conclusion: Taken together, the findings of these bioinformatics analyses identified key hub genes associated with the development of myocardial infarction in diabetics. These hub genes and potential drugs may become novel biomarkers for prognosis and precision treatment in the future.

Mirnas as Potential Diagnostic Tool for Diabetes-Linked Myocardial Infarction

Cardiovascular diseases affect millions of people worldwide with a prevalence of 17.9 deaths in 2019. Myocardial infarction (MI) is the initial indicator of heart failure associated with reduced blood flow causing cardiac cell apoptosis. Diabetic patients exhibit a 2-4 fold increase in risk in the development of cardiovascular disease, especially MI. Material and Methods We have used Gene Target Registry (GTR) and National Center for Biotechnology Infromation database to find dysregulated genes in diabetes-linked MI patients. Insilico analysis was done to find miRNAs targeting the dysregulated genes by using Targetscan, miRBase, and miRanda databases. MicroRNAs (miRNAs) were isolated from peripheral blood of diabetic MI patients'admitted in Lady Reading Hospital Peshawar, and western blot was used to assess its target protein expression – recipocal conformation of miRNA expression levels with its target protien inhibition. qRT-PCR and various biochemical assays were performed to explore the diagnostics potential of circulatory miRNAs including miR-15 in a diabetic MI patients’ blood. Results In this study, we identify many genes which have the 8-mers binding site of miRNA by using various bioinformatics tools. We find out that various genes including KCNQ1, CDKN2A, CDKN2B-AS1, and VEGF are dysregulated in diabetes-linked MI. KCNQ1 is a putative target of miRNA-365a and miRNA-365b. CDKN2A is another target of miR-484, miR-3155, miR-4466, miR-675, miR-6804, and miR-500. miR-15a is upregulated in diabetes linked MI patients, Vascular endothelial growth factor (VEGF) is the putative target of miRNA-15a. In addition, the bioinformatics analysis showed that VEGF has the target site for other miRNAs including miRNA-16, miRNA-195, miR-6838, miR-497, miR-424. Further expression analysis have confirmed miR-15a to be upregulated in diabetic MI patients’ blood. Conclusion Conclusively, these miRNAs may sever as a diagnostic marker for diabetes link MI. Furthermore, the circulatory miR-15a exhibits diagnostic potential for diabetes link MI and provide a therapeutic target for MI in diabetic patients.

Correlation between Carbonic Anhydrase Isozymes and the Evolution of Myocardial Infarction in Diabetic Patients.

Simple SummaryHeart disease in diabetics presents distinctive characteristics both anatomically and physiopathologically compared to non-diabetics. In people with diabetes, high blood pressure has a high incidence (approximately one-third of diabetic patients have high blood pressure) and is a risk factor for diabetic macro- and microvascular complications. The correlation of these parameters could represent early markers of the prognosis and evolution of diabetic patients with acute myocardial infarction and their routine determination could be included in the biological algorithm of acute myocardial infarction, but understanding of this aspect must be deepened in the future. The results showed that diabetic patients develop acute myocardial infarction more frequently, regardless of age. The level of the enzymes of myocardial necrosis was higher in diabetics compared to non-diabetics, and acute coronary syndrome occurs mainly in diabetics with inadequate metabolic balance. Our research may provide useful information for the medical community.(1) Background: Myocardial infarction was, until recently, recognized as a major coronary event, often fatal, with major implications for survivors. According to some authors, diabetes mellitus is an important atherogenic risk factor with cardiac determinations underlying the definition of the so-called “diabetic heart”. The present study aims to establish a correlation between the evolution of myocardial infarction in diabetic patients, by determining whether lactic acid levels, the activity of carbonic anhydrase isoenzymes, and the magnitude of ST-segment elevation are correlated with the subsequent evolution of myocardial infarction. (2) Methods: The study analyzed 2 groups of 30 patients each: group 1 consisted of diabetic patients with acute myocardial infarction, and group 2 consisted of non-diabetic patients with acute myocardial infarction. Patients were examined clinically and paraclinical, their heart markers, lactic acid, and the activity of carbonic anhydrase I and II isozymes were determined. All patients underwent electrocardiogram and echocardiography analyses. (3) Results: The results showed that diabetics develop acute myocardial infarction more frequently, regardless of how much time has passed since the diagnosis. The value of myocardial necrosis enzymes was higher in diabetics than in non-diabetics, and acute coronary syndrome occurs mainly in diabetics with poor metabolic balance. Lethality rates in non-diabetic patients with lactic acid values above normal are lower than in diabetics. (4) Conclusions: Lactic acid correlated with the activity of isozyme I of carbonic dioxide which could be early markers of the prognosis and evolution of diabetic patients with acute myocardial infarction.

Raised Glycated Hemoglobin (HbA1c) Level as a Risk Factor for Myocardial Infarction in Diabetic Patients: A Hospital-Based, Cross-Sectional Study in Peshawar

BackgroundDiabetes is a rapidly rising chronic illness in developing countries. The main objective of this research is to compare the frequency of myocardial infarction (MI) in controlled and uncontrolled diabetics in Pakistan, especially in the underprivileged district of Peshawar, and to determine raised blood glucose as a risk factor for MI.MethodologyThis cross-sectional study involving 237 diabetic patients aged 30-80 years was conducted in three major tertiary care hospitals in Peshawar, Pakistan. The inclusion criteria were diabetic patients with glycated hemoglobin (HbA1C) levels of less than 7% considered to be “controlled diabetics” and above 7% considered to be “uncontrolled diabetics.” Data were collected using structured questionnaires, past medical records, and patient history and were analyzed using SPSS software (IBM Corp., Armonk, NY, USA). The study was concluded in March 2022.ResultsThe highest number of MIs occurred in diabetics with HbA1c levels of 8-9% (47.9% of all MIs). There was a significant association between increasing HbA1c levels and the incidence of MI (p = 0.002). The adjusted prevalence odds ratio for MI in uncontrolled diabetics was 6.105 (95% confidence interval = 2.42-15.43), that is, six times increased incidence of MI in patients with HbA1c of more than 7%. Furthermore, with a 1% increase in HbA1c, there was a 10% increase in the proportion of MIs.ConclusionsFrom this study, it is clear that HbA1c levels of 8-9% were most significantly associated with the risk of MI in uncontrolled diabetics, and with rising levels of HbA1c, the risk of MI increased significantly. Thus, this study highlights the importance of HbA1c control in diabetic patients to prevent a heart attack.

Prediction of late complications of acute myocardial infarction in diabetic patients

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Kharkiv national medical university Background The combination of acute myocardial infarction (AMI) and type 2 diabetes mellitus (DM) is common in patients, and the prognosis is usually worse than in patients without type 2 DM. Late complications of AMI in the presence of type 2 DM have a negative impact on the viability of patients. Purpose To predict the development of late complications in patients with AMI and concomitant type 2 DM. Methods A total of 109 ST elevation myocardial infarction (STEMI) and 2 type DM patients were included. The patients were treated from 01 September 2018 till 31 December 2020. The study involved clinical assessment of the patient’s condition, C1q tumor necrosis factor - related protein 3 (CTRP3) and adropin quantification. Late complications of AMI were included atrial fibrillation, atrioventricular blockage, chronic heart failure 2-3 functional classes, aneurysm of the apex and ventricular, ejection fraction ≤49%. We measured serum-concentrations of CTRP 3 and adropin by enzyme immunoassay. Reference values of CTRP 3 were 315.85 (287.06 – 371.02) ng/ml and adropin – 23.58 (20.86 – 26.29) pg/ml. Qualitative data were presented as percentages; quantitative as median and interquartile range (25 and 75 percentiles). The nonparametric Mann-Whitney rank criterion was used to compare quantitative indicators. Binary logistic regression was used to build a model for predicting late complications in patients with AMI with type 2 DM. Results In total, 75 men (68.8%) and 34 women (31.2%) were included in the study. CTRP 3 levels on day 14 in patients with AMI and type 2 DM was determined 262.01 (225.32 – 288.84) ng/ml and adropin concentration on day 14 - 19.97 (16.35 – 20.99) pg/ml according to CTRP 3 reference values (p<0.05). No late complications were identified in 9 patients and 65 patients had late complications. The most important indicators for constructing the model were: CTRP3 quality, adropin quality, total cholesterol (TC), triglycerides on day 14 (TG), ejection fraction (EF) on day 14, low density lipoproteides (LDL) on day 14, the size of the left atrium on day 14 (LA). Binary logistic regression was used to obtain a mathematical model in order to determine the probability of developing late complications (P) of AMI: P=[1+ exp(-4.046×Adropin-2.714×CTRP3+6.270×TC-2.988×TG-0.288×EF-7.407×LDL-1.398×LA+19.259)]-1.The accuracy of the model was 94.6%. Conclusion This study showed that the use of a model to detect late complications of AMI may in the long term predict the development of uncomfortable cardiovascular events of AMI, accompanied by type 2 DM. Of course, the sample size was relatively small, which should be increased in the future to confirm the findings.

Mortality in patients with myocardial infarction and potential risk factors: A five-year data analysis.

Coronary artery disease (CAD) is among the most common causes of death in almost all countries across the world. Awareness of risk factors for the management and prevention of the disease can reduce complications and mortality rates. This study was conducted with the aim to investigate the mortality and potential risk factors of myocardial infarction (MI) as well as their relationships in patients who were admitted to one university hospital in the North of Iran from 2014 to 2018. This study had retrospective descriptive design. Using a checklist, all necessary information was extracted from 5-year medical records data of MI patients in the university hospital from 2014 to 2018 (n = 564). The data analysis was performed in SPSS software using descriptive statistics and two binary logistic regression analyses. The results showed that the mean age of the patients was 62.78 ± 13.38 years, and most of them were men (66.3%). The patients' mortality was 18.6% in a 5-year analysis. However, the number of mortalities was higher in the women (P = 0.001). Descriptive analysis showed that the most common risk factors of the disease in both genders were hypertension (46.6%), diabetes mellitus (DM) (38.5%), hyperlipidemia (24.1%), smoking (20%), and family history of CVDs (18.8%), respectively. However, the results of the adjusted regression model showed that the odds ratio (OR) of the patients' mortality increased in diabetic MI patients (OR: 2.33; 95%CI: 1.42-3.81; P = 0.001), but this ratio decreased in MI patients with a history of hyperlipidemia (OR: 0.23; 95%CI: 0.11-0.44; P ˂ 0.001). Based on the results, individual- and population-based prevention strategies by focusing on hypertension and diabetes are recommended in our health programs. Surprisingly, the mortality rate of MI patients was lower among those with a history of hyperlipidemia. There are different hypotheses for the cause of this. Therefore, laboratory studies with animal models and prospective cohorts are suggested for future studies.

Efficacy and safety of sacubitril valsartan in treating heart failure with midrange ejection fraction after acute myocardial infarction in diabetic patients.

Objective to evaluate the clinical efficacy and safety of sacubitril valsartan in the treatment of heart failure (HF) with midrange ejection fraction after acute myocardial infarction (AMI) in diabetic patients. From January 2015 to July 2020, HF patients with diabetes mellitus complicated with AMI were retrospectively analyzed. According to the medication, they were divided into 2 groups, that is, sacubitril valsartan group (84 cases) and valsartan group (86 cases). Valsartan group took valsartan capsule (80 mg/capsule, Beijing Novartis Pharmaceutical Co., Ltd) 80 mg, qd, on the basis of routine treatment. On the basis of routine treatment, the sacubitril valsartan group took sacubitril valsartan sodium tablets (50 mg/tablet, Beijing Novartis Pharmaceutical Co., Ltd), the initial dose was 25 mg, bid, and gradually increased to the target dose according to the patient's blood pressure. After 12 months of treatment, the independent sample t test showed that the left ventricular end diastolic dimension in the sacubitril valsartan group was lower than that in the valsartan group [(47.26 ± 4.71) mm vs (50.05 ± 5.62) mm, P < .001]. The left ventricular ejection fraction in the sacubitril valsartan group was higher than that in the valsartan group [(54.76 ± 4.24)% vs (49.28 ± 3.74)%, P < .001]. χ2 inspection showed that the readmission rate in the sacubitril valsartan group was lower than that in the valsartan group (7.14% vs 18.60%, P < .05). Sacubitril valsartan has good safety and tolerability in patients with diabetes mellitus complicated with AMI who have HF with midrange ejection fraction. Compared with valsartan, sacubitril valsartan can improve the left ventricular function better and reduce the readmission rate due to HF in these patients.

Опасности и трудности при диагностике инфаркта миокарда у пациентов с сахарным диабетом (обзор литературы и собственный опыт)

В статье проведен краткий анализ последних исследований (2010–2020 гг.) по проблеме менеджмента острого инфаркта миокарда у пациентов с сопутствующим сахарным диабетом (СД). Авторы приводят новые данные об эпидемиологии и особенностях клинической картины острого коронарного синдрома при СД, сделав акцент на атипичных формах болевого синдрома. Также приведены результаты собственных исследований. Был проведен ретроспективный анализ медицинских карт 41 пациента (33 мужчин и 8 женщин), госпитализированных по поводу инфаркта миокарда. Из них 6 пациентов (14,63 %) — с сопутствующим СД типа 2. У 5 пациентов (83,33 %) с СД наблюдался типичный болевой синдром умеренной интенсивности, 1 пациент (16,67 %) жаловался только на общее недомогание и незначительный дискомфорт в груди. У 2 пациентов (33,33 %) с СД наблюдались головокружение и потливость. Все пациенты с СД жаловались на выраженную общую слабость. У больных СД также отмечались единичные случаи внезапного появления непонятных симптомов в груди (n = 2), конечностях (n = 1), головокружения (n = 3), кратковременной потери сознания (n = 2), которым предшествовали боль (n = 3), дискомфорт (n = 1), ощущение сжатия в грудной клетке (n = 1), за грудиной (n = 1) или в области сердца (n = 2). Однако эти случаи носили спорадический характер и у каждого больного комбинировались с различными специфическими для острого коронарного синдрома симптомами.

Risk Assessment of Myocardial Infarction for Diabetics through Multi-Aspects Computing

INTRODUCTION: Myocardial infarction (MI) is a type of cardiovascular disease. Cardiovascular disease is the major side effect of diabetes. It causes damage to heart muscle due to interruption in the blood flow. The chance of getting this disease is high in diabetes patients.OBJECTIVES: To choose a dataset with features related to diabetes, parameters of ECG and risk factors of MI for effective prediction. Predict myocardial infarction in both type-1 and type-2 diabetic patients using regression techniques. Recognise the best algorithm.METHODS: Multiple linear regression, ridge regression and lasso regression are existing techniques in addition to which proposed technique lasso regression is used to develop a model for prediction. The trained models are compared to know better performing algorithm. Estimation statistics namely confidence and prediction intervals are used to show the amount of uncertainty in predicted values. The statistical measures in regression analysis namely root mean squared error and r_squared value are used to evaluate and compare algorithms.RESULTS: The proposed algorithm ‘lasso regression’ has achieved better values of RMSE and r_squared as 0.418 and 0.2278 respectively compared to remaining techniques.CONCLUSION: Best performance of proposed algorithm was noticed and hence using lasso regression for prediction of myocardial infarction in diabetes patients gives better results.

Impact of pre-treatment with acetylsalicylic acid on the severity of a first myocardial infarction in diabetic patients

Abstract Introduction Diabetes Mellitus (DM) is one of the main risk factors for cardiovascular disease (CVD). Guidelines on the use of acetylsalicylic acid (ASA) for primary prevention of CVD in this population are conflicting. A potential reduction in the severity of a first episode of Acute Myocardial Infarction (AMI) could be seen has an additional argument for the use of ASA in primary prevention. Aim: To evaluate the impact of prior intake of ASA on the presentation, severity and short-term prognosis of AMI in diabetic patients without history of CVD. Methods Retrospective analysis of diabetic patients without previous evidence of CVD diagnosed with type 1 AMI between January 2002 and December 2018, inserted in a multicentric registry of acute coronary syndromes. Patients were dichotomized according to whether or not they were taking ASA prior to the index event. Groups were compared according to clinical, analytical and imaging endpoints. Results A total of 2596 patients were included, predominantly men (66.4%), with a mean age of 68±12 years old. Patients on ASA (19.7%) were significantly older (71±10 vs. 67±12, p&amp;lt;0.001) and had a higher prevalence of hypertension (89.2% vs 77.9%, p&amp;lt;0.001), dyslipidaemia (69.8% vs. 61.1%, p&amp;lt;0.001) and chronic kidney disease (10.6% vs. 4.9%, p&amp;lt;0.001). Overall, there was a lower prevalence of AMI with ST-segment elevation (36.5% vs. 50.8%, p&amp;lt;0.001) in patients on ASA. However, the same group of patients had a significantly higher probability of evolution in Killip class &amp;gt; I (25.4% vs. 17.0%, p&amp;lt;0.001), a higher median BNP elevation (315 [126–623] vs. 166 [64–431], p&amp;lt;0.001); and a lower average ejection fraction upon discharge (49.0±12 vs. 51±12, p=0.011). Patients on prior regular intake of ASA also had a higher prevalence of multivessel disease (38.4% vs. 28.9%, p&amp;lt;0.001) and multiple significant stenosis (70.2% vs. 61.7%, p&amp;lt;0.001). There was no significant difference regarding the percentage of electrical complications (2.3% vs. 1.2%, p=0.06), use of intra-aortic balloon pump (1.0 vs. 0.9%, p=0.74) and in-hospital death (3.0% vs. 2.4%, p=0.46). In a logistic regression model adjusted for age, sex, comorbidities and previous medication as variates, prior ASA intake was an independent predictor of a lower rate of AMI with ST-segment elevation (ExpB −0.34; 95% CI: 0.57–0.89; p=0.003). On the contrary, when adjusted to these variables, prior ASA intake was not an independent predictor of higher BNP (p=0.13) or higher probability of multivessel disease (p=0.22) or presence of ≥1 significant stenosis (p=0.31). Conclusions In this population of diabetic patients with a first episode of ACS, prior use of ASA in the context of primary prevention was associated with a significant lower rate of ST-segment elevation myocardial infarction. Funding Acknowledgement Type of funding source: None

Incidence, predictors and outcomes of stress hyperglycemia in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Background:Stress hyperglycemia is a common finding during ST elevation myocardial infarction in diabetic patients and is associated with a worse outcome. However, there are limited data about stress hyperglycemia in non-diabetic patients and its outcome especially in patients undergoing primary percutaneous coronary intervention.Methods:The study was conducted on 660 patients with ST elevation myocardial infarction who were managed with primary percutaneous coronary intervention. Patients were classified into two groups according to the presence of stress hyperglycemia: group I (patients with stress hyperglycemia) and group II (patients without stress hyperglycemia). Patients were analysed for clinical outcome including mortality and the occurrence of major adverse cardiac events.Results:Incidence of stress hyperglycemia was 16.8%, multivariate regression analysis identified the independent predictors of stress hyperglycemia, that were family history of diabetes mellitus odds ratio 1.697 (95% confidence interval: 1.077–2.674, p = 0.023), body mass index >24 kg/m2 odds ratio 1.906 (95% confidence interval: 1.244–2.922, p = 0.003) and cardiogenic shock on admission odds ratio 2.517 (95% confidence interval: 1.162–5.451, p = 0.019). Mortality, cardiogenic shock, contrast induced nephropathy and no reflow phenomenon were significantly higher in stress hyperglycemia group with p value = 0.027, 0.001, 0.020 and 0.037, respectively.Conclusion:Stress hyperglycemia in non-diabetic patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention is associated with increased incidence of no reflow phenomenon, contrast induced nephropathy, cardiogenic shock and higher mortality.

Myocardial infarction in diabetic patients and cardiovascular risk factors control

Myocardial infarction in diabetic patients and cardiovascular risk factors control

Acute myocardial infarction and diabetes mellitus: Is admission glycosylated hemoglobin predictive of one-year major adverse cardiovascular events?

In diabetic patients with acute myocardial infarction (MI), prognostic value of glycosylated hemoglobin (HbA 1c ) remains debated. In a large observational study, we aimed to identify the prognostic value of HbA 1c measured on admission for acute MI in diabetic patients regarding one-year major adverse cardiovascular events (MACE). From the RICO survey database, all consecutive patients with or without known diabetes with acute MI ( N = 3005) from January 2001 to June 2016 were included. We divided our population into 4 quartiles: HbA 1c ≤ 6.5% ( N = 807), 6.5–7% ( N = 722), 7.2–8.1% ( N = 748), ≥ 8.2% ( N = 728) for the analysis. On admission, median age was 73 years old, median HbA 1c and glucose were 7.0% and 9.6 mmol/L. Compared to HbA 1c ≤ 6.5% group, HbA 1c ≥ 8.2% group was made up of younger persons (74 vs. 70 years old, P < 0.001), had most important body mass index > 30 kg/m 2 (221 (28%) vs. 241 (33%), P = 0.041), had less important high blood pressure rate (610 (76%) vs. 508 (70%), P = 0.016) and had a stronger anti-diabetic treatment (insulin plus oral anti-diabetic medication: 44 (6%) vs. 176 (24%), P < 0.001). Regarding the clinical data, HbA 1c ≥ 8.2% group had more STEMI (372 (46%) vs. 395 (54%), P = 0.002), more multi-vessel disease (446 (60%) vs. 455 (67%), P = 0.007) but lower GRACE score (156 vs. 150, P = 0.020) than HbA 1c ≤ 6.5% group. We did not observed any difference concerning one year MACE between the 4 groups (HbA 1c ≤ 6.5%: 243 (30.1%); 6.6–7.0%: 227 (31.4%); 7.1–8.1%: 246 (32.9%); ≥ 8.2%: 239 (32.8%), P = 0.6). Even in case of extreme glycometabolic chronic derangement, our results showed that the initial HbA1c has no one-year prognostic significance value after acute MI in our large diabetic population. However, these patients remain in a high-risk cardiovascular population and need close multidisciplinary follow-up. The chronical hyperglycemia prognostic value should be studied over a much longer period.

Coronary computed tomography angiography as a tool for long-term cardiovascular risk stratification in diabetic patients.

Objectives of the study were to examine the long-term prognostic power of coronary computed tomography angiography (CCTA) to predict death or myocardial infarction in patients with diabetes mellitus (DM). The prognostic value of CCTA in diabetic patients has been confirmed for short- and intermediate follow-up durations. The slowly progressing nature of coronary artery disease (CAD), however, underlines the necessity to validate CCTA for longer observation periods in this high-risk population. A total of 132 patients with DM and 1781 without DM were examined by CCTA and followed for a median duration of 9.7 (IQR 6.9, 11.2) and 9.9 (IQR 6.9, 11.1) years, respectively. Cox proportional hazards analysis was used for the composite endpoint of death and myocardial infarction. Warranty period was defined as the number of years that an individual stays in a low-risk group with a cumulative probability for the endpoint below 1% and calculated for patients with/without DM and rising degrees of CAD. The study endpoint was reached in 12 (9.1%) patients with and 87 (4.9%) patients without DM (p = 0.024). Quantification of coronary stenosis by CADRADS or CAD severity (normal/non-obstructive/obstructive) was incremental for endpoint prediction with a multivariate (+Morise) χ2 of 3.90 and 3.85, respectively. The lowest annual event rate of 0.19% was noted in non-diabetic patients with no CAD, translating to a warranty period of 5.26years. The highest annual event rate of 1.73% was found in diabetic patients with obstructive CAD, corresponding to a warranty period of 0.58years. Compared to patients with no DM and no CAD, the risk of death or myocardial infarction in diabetic patients increased with rising levels of coronary obstruction at multivariate hazard ratios (HR) of 3.28 [95% CI 2.32, 4.64 (p < 0.001)], 3.02 [95% CI 2.19, 4.17 (p < 0.001)] and 9.40 [95% CI 4.90, 18.03 (p < 0.001)] for normal coronary arteries, non-obstructive CAD and obstructive CAD. This study validates the long-term prognostic utility of CCTA-assessed CAD for predicting death or myocardial infarction in a population of patients with DM. The rates of death or myocardial infarction rise with CAD severity in diabetic and non-diabetic patients, identifying the highest risk group of patients with DM and obstructive CAD.

Glycemic variability as a predictor of major adverse cardiac events after percutaneous coronary intervention

Background: The endothelial dysfunction was greater by glucose fluctuation than by chronic hyperglycemia. The glycemic variability (GV) may be an independent risk factor for atherosclerotic coronary artery disease in diabetic patients. The cardiovascular complications are higher following myocardial infarction in diabetic patients than nondiabetic individuals. Aim of the Work: Our aim is to prove that good controlling of acute shooting of blood glucose level up and down will improve the outcome in patient undergoing percutaneous coronary intervention (PCI). Subjects and Methods: GV is evaluated using intraday variability by fasting, preprandial, and postprandial blood glucose levels in 120 patients. Hemoglobin A1c was used to evaluate glycemic control. The relationship between GV and development of major adverse cardiac events (MACE) in patients undergoing PCI is studied. Results: There is a statistically significant difference between the relation of GV and MACE within 1 month after PCI in uncontrolled diabetes compared to controlled group. There is no statistically significant difference found between the two groups regarding age, gender, risk factors (hypertension, smoking and dyslipidemia), and laboratory parameters including triglycerides, total cholesterol, low-density lipoprotein, and high-density lipoprotein. Conclusions: Uncontrolled GV is associated with poor short-term outcome after PCI in controlled diabetic patients compared to nondiabetic individuals undergoing PCI. Greater GV is associated with composite MACE, especially for uncontrolled diabetic patients. After multivariable logistic analysis, GV remains an independent prognostic factor for composite MACE after 3 months in patients undergoing PCI.

Association of HbA1c with coronary heart diseases like ischemic heart disease and myocardial infarction in diabetic patients

Association of HbA1c with coronary heart diseases like ischemic heart disease and myocardial infarction in diabetic patients

Acute myocardial infarction and diabetes mellitus: Is admission glycosylated hemoglobin predictive of one-year major adverse cardiovascular events?

In diabetic patients with acute myocardial infarction (MI), prognostic value of glycosylated hemoglobin (HbA1c) remains debated. In a large observational study, we aimed to identify the prognostic value of HbA1c measured on admission for acute MI in diabetic patients regarding one-year major adverse cardiovascular events (MACE). From the RICO survey database, all consecutive patients with or without known diabetes with acute MI ( n = 3005) from January 2001 to June 2016 were included. We divided our population into 4 quartiles: HbA1c ≤ 6.5% ( n = 807), 6.5–7% ( n = 722), 7.2–8.1% ( n = 748), ≥ 8.2% ( n = 728) for the analysis. On admission, median age was 73 years old, median HbA1c and glucose were 7.0% and 9.6 mmol/L. Compared to HbA1c ≤ 6.5% group, HbA1c ≥ 8.2% group was made up of younger persons (74 vs. 70 years old, P < 0.001), had most important body mass index > 30 kg/m 2 (221 (28%) vs. 241 (33%), P = 0.041), had less important high blood pressure rate (610 (76%) vs. 508 (70%), P = 0.016) and had a stronger anti-diabetic treatment (insulin plus oral anti-diabetic medication: 44 (6%) vs. 176 (24%), P < 0.001). Regarding the clinical data, HbA1c ≥ 8.2% group had more STEMI [372 (46%) vs. 395 (54%), P = 0.002], more multi-vessel disease [446 (60%) vs. 455 (67%), P = 0.007] but lower GRACE score (156 vs. 150, P = 0.020) than HbA1c ≤ 6.5% group. We did not observed any difference concerning one year MACE between the 4 groups [HbA1c ≤ 6.5%: 243 (30.1%); 6.6–7.0%: 227 (31.4%); 7.1–8.1%: 246 (32.9%); ≥ 8.2%: 239 (32.8%), P = 0.6]. Even in case of extreme glycometabolic chronic derangement, our results showed that the initial HbA1c has no one-year prognostic significance value after acute MI in our large diabetic population. However, these patients remain in a high-risk cardiovascular population and need close multidisciplinary follow-up. The chronical hyperglycemia prognostic value should be studied over a much longer period.

One quarter of total myocardial infarctions are silent manifestation in patients with type 2 diabetes mellitus

BackgroundSilent events with newly developed Q waves in electrocardiogram (ECG) [silent myocardial infarction (MI)] in diabetic patients is reported to be independently associated with an increased risk of fatal MI. However, the incidence rate of silent MI in diabetic patients has yet to be clarified. We sought to determine the incidence rate of first symptomatic MI and silent MI in diabetic patients. MethodsWe conducted a prospective cohort study on patients enrolled in the Japanese primary prevention of atherosclerosis with aspirin for diabetes (JPAD) trial which was started in 2002. It is a randomized controlled trial to examine the efficacy of low-dose aspirin therapy for the primary prevention of atherosclerotic events in type 2 diabetic patients. No patients had Q waves in their ECG before entry to the JPAD trial. We followed-up 1825 patients until July 2015 after completion of the JPAD trial in 2008. The median follow-up period was 10.3 years. We collected 1648 patients’ ECGs to identify patients with silent MI. ResultsSymptomatic MI occurred in 65 patients and silent MI occurred in 22 patients. The incidence rate of symptomatic MI was 4.26 per 1000 patient-years and 1.44 for silent MI in diabetic patients. Thus, 25% of total MIs were silent. Cause-specific Cox proportional hazard model indicated that age (hazard ratio 1.06, 95% confidence interval; 1.03–1.10, p=0.0004) and long history of diabetes (1.00, 1.01–1.07, p=0.01) were independently associated with symptomatic MI, but these were not associated with silent MI. ConclusionsWe demonstrated that incidence rate of first silent MI and that proportion of silent MI to all MIs was 25% in diabetic patients without a history of atherosclerotic events. Diabetic patients frequently need ECG screening for detection of silent MI.