Impact of glycemic gap on 30-day adverse outcomes in patients with acute ST-segment elevation myocardial infarction. (November 2022)

• Record Type: Journal Article
• Authors: Wu, Shuang; Yang, Yan-min; Zhu, Jun; Xu, Wei; Wang, Lu-lu; Lyu, Si-qi; Wang, Juan; Shao, Xing-hui; Zhang, Han
• Is Part Of: Atherosclerosis. Volume 360(2022)
• Page Start: 34
• Page End: 41
• Publication Date: 2022-11
• Subjects: ST-segment elevation myocardial infarction -- Glycemic gap -- Stress-induced hyperglycemia -- All-cause mortality -- Major adverse cardiovascular events; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2022.10.003
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background and aims: Stress-induced hyperglycemia (SIH) generally occurs in critical illness. Recently, glycemic gap (GAP) has been considered to be a superior indicator of SIH. However, data on the association between GAP and prognosis in ST-segment elevation myocardial infarction (STEMI) is limited. This observational study aimed to estimate the prognostic value of GAPmean, defined as the difference between mean blood glucose level (MGL) within 24 h after admission and A1c-derived average glucose (ADAG), in patients with acute STEMI. Methods: A total of 4952 patients with acute STEMI were included in the final analysis, and they were divided into four groups according to GAPmean quartiles and diabetes mellitus (DM). The primary outcomes were all-cause mortality and major adverse cardiovascular events (MACEs). Cox proportional hazards regression analysis and net reclassification improvement (NRI) analysis were performed. Results: At 30 days of follow-up, 324 (6.5%) deaths and 569 (11.5%) MACEs occurred. With the elevation of GAPmean, the incidence of all-cause mortality (4.0%, 5.6%, 6.5%, and 10.1%) and MACEs (7.3%, 9.6%, 11.4%, and 17.7%) significantly increased. Receiver operating characteristic curve analysis demonstrated that GAPmean was superior to admission blood glucose (ABG) and GAPadm (defined as the difference between ABG and ADAG) to detect adverse outcomes. Multivariate Cox regression analysis revealed that elevated GAPmean was independently associated with all-cause death and MACEs. With the first quartile as a reference, the hazards ratios (HRs) for all-cause death in the second, third, and fourth quartiles were 1.49 (95% CI 1.02–2.18), 1.58 (95% CI 1.09–2.30), and 2.11 (95% CI 1.48–3.02), respectively, and the HRs for MACEs were 1.40 (95% CI 1.05–1.86), 1.60 (95% CI 1.21–2.11), and 2.17 (95% CI 1.66–2.83), respectively, which were independent of DM status. Continuous NRI analysis revealed that GAPmean significantly improved risk stratification for all-cause mortality and MACEs by 21.6% and 19.8%, respectively. Conclusions: The glycemic gap between MGL within 24 h after admission and ADAG was independently associated with 30-day all-cause mortality and MACEs in patients with acute STEMI, which was not affected by DM status. Further, the glycemic gap provided incremental accuracy in the risk stratification of STEMI. Graphical abstract: Image 1 Highlights: Elevated GAPmean is independently related to 30-day all-cause death and MACEs in STEMI, independent of the status of DM. GAPmean is superior to admission blood glucose and GAPadm in the prediction of all-cause death and MACEs in STEMI. GAPmean can provide additional accuracy in risk stratification of STEMI beyond that provided by conventional risk factors.