The significance of glycated haemoglobin, randomized admission blood glucose, and fasting blood glucose on in-hospital adverse cardiac events in patients with ST-elevation acute myocardial infarction

https://doi.org/10.19106/JMedSci005401202204

Anggoro Budi Hartopo(1*), Vina Yanti Susanti(2), Vita Yanti Anggraeni(3)

(1) Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital, Yogyakarta, Indonesia
(2) Division of Endocrinology and Metabolic Disease, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital, Yogyakarta, Indonesia
(3) Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital, Yogyakarta, Indonesia
(*) Corresponding Author

Abstract


In an ST-segment elevation acute myocardial infarction (STEMI), glucose metabolism undergoes disturbance secondary to acute myocardial injury, which affects the clinical outcome during the acute phase. Glucose metabolic disturbance indices are glycated haemoglobin, admission random glucose, and fasting glucose in blood circulation during STEMI. This is a retrospective cohort study, aimed to investigate whether glycated haemoglobin, admission random blood glucose, and fasting blood glucose levels are the risk factors for developing in-hospital adverse cardiac events in STEMI. The result showed that among the three glucose metabolic disturbance indices, fasting glucose was an independent predictor (adjusted OR: 1.010 (95% CI: 1.001-1.018) and the most accurate factor (AUC 64.9 %) for adverse cardiac events. Other glucose metabolic indices, namely random blood glucose and glycated haemoglobin, were associated with increased odds to develop adverse cardiac events but they did not independently predict adverse cardiac events. Therefore, fasting blood glucose was an independent predictor and the most accurate factor for adverse cardiac events in the acute event of STEMI.


Keywords


STEMI; glucometabolic; fasting blood glucose; cardiac events

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References


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https://doi.org/10.1001/jama.2011.522
2.Steg PG, James SK, Atar D, Badano LP, Lunqvist CB, Borger MA, et al. ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012; 33(20):2569-619.
https://doi.org/10.1093/eurheartj/ehs215
3.O’Gara PT, Kushner FG, Ascheim DD, Casey Jr DE, Chung MK, de Lamos JA, et al, 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 61(4):e78-e140.
https://doi.org/10.1016/j.jacc.2012.11.019
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https://doi.org/10.4021/cr56w
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https://doi.org/10.7860/JCDR/2017/24803.9481
6.Knudsen EC, Seljeflot I, Abdelnoor M, Eritsland J, Mangschau A, Arnesen H, et al. Abnormal glucose regulation in patients with acute ST-elevation myocardial infarction-a cohort study on 224 patients. Cardiovasc Diabetol 2009; 8:6.
https://doi.org/10.1186/1475-2840-8-6
7.Stratton IM, Adler AI, Neil HA, Matthews DR, Cull CA, Hadden D, et al. Association of glycaemic control with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321(7258):405-12.
https://doi.org/10.1136/bmj.321.7258.405
8.Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycaemia and the risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet 2000; 355(9206):773-8.
https://doi.org/10.1016/S0140-6736(99)08415-9
9.Norhammar A, Tenerz A, Nilsson G, Efendic S, Ryden L, Malmberg K. Glucose metabolism in patients with myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet 2002; 359(9324):2140-4.
https://doi.org/10.1016/S0140-6736(02)09089-X
10.Timmer JR, Hoekstra M, Nijsten MWN, van der Horst ICC, Ottervanger JP, Slingerland RJ, et al. Prognostic value of admission glycosylated hemoglobin and glucose in nondiabetic patients with ST-segment-elevation myocardial infarction treated with percutaneous coronary intervention. Circulation 2011; 124(6):704-11.
https://doi.org/ 10.1161/CIRCULATIONAHA.110.985911
11.O'Sullivan JJ, Conroy RM, Robinson K, Hickey N, Mulcahy R. In-hospital prognosis of patients with fasting hyperglycemia after first myocardial infarction. Diabetes Care 1991; 14(8):758-60.
https://doi.org/10.2337/diacare.14.8.758
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https://doi.org/10.1161/01.cir.99.20.2626
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https://doi.org/10.1093/eurheartj/ehi199.
14.Hartopo AB, Sukmasari I, Puspitawati I. The utility of point of care test for soluble ST2 in predicting adverse cardiac events during acute care of ST-segment elevation myocardial infarction. Cardiol Res Pract 2018; 2018:3048941.
https://doi.org/10.1155/2018/3048941
15.Hartopo AB, Puspitawati I, Mumpuni H. The ratio of circulating endothelin-1 to endothelin-3 associated with TIMI risk and dynamic TIMI risk score in ST elevation acute myocardial infarction. Can J Physiol Pharmacol 2020; 98(9):637-43.
https://doi.org/10.1139/cjpp-2019-0654
16.Lazzeri C, Valente S, Chiostri M, Picariello C, Gensini GF. Acute glucose dysmetabolism in the early phase of ST-elevation myocardial infarction: the age response. Diab Vasc Dis Res 2010; 7(2):131-7.
https://doi.org/10.1177/1479164109353369
17.Lazzeri C, Valente S, Chiostri M, Picariello C, Gensini GF. In-hospital peak glycemia and prognosis in STEMI patients without earlier known diabetes. Eur J Cardiovasc Prev Rehabil 2010; 17(4):419-23.
https://doi.org/10.1097/HJR.0b013e328335f26f
18.Kewcharoen J, Ali M, Trongtorsak A, Mekraksakit P, Vutthikraivit W, Kanjanauthai S. Admission hyperglycemia is associated with reperfusion failure in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis. Am J Cardiovasc Dis 2021; 11(3):348-59.
19.Liu J, Wang S, Cui C, Cai H, Sun R, Pan W, et al. The association between glucose-related variables and plaque morphology in patients with ST-segment elevated myocardial infarction. Cardiovasc Diabetol 2020; 19(1):109.
https://doi.org/10.1186/s12933-020-01074-9
20.Moura FA, Figueiredo VN, Teles BSBS, Barbosa MA, Pereira LR, Costa APR, et al. Glycosylated hemoglobin is associated with decreased endothelial function, high inflammatory response, and adverse clinical outcome in non-diabetic STEMI patients. Atherosclerosis 2015; 243(1):124-30.
https://doi.org/10.1016/j.atherosclerosis.2015.09.004
21.Tsai JP, Tian J, Wang WYS, Ng ACT. Glycated hemoglobin vs fasting plasma glucose as a predictor of left ventricular dysfunction after ST-elevation myocardial infarction. Can J Cardiol 2015; 31(1):44-9.
https://doi.org/10.1016/j.cjca.2014.10.029
22.Lazzeri C, Valente S, Chiostri M, Picariello C, Attanà P, Gensini GF. The prognostic impact of glycated hemoglobin in diabetic ST-elevation myocardial infarction. Int J Cardiol 2011; 151(2):250-2.
https://doi.org/10.1016/j.ijcard.2011.06.077
23.Yang CD, Shen Y, Ding FH, Yang ZK, Hu J, Shen WF, et al. Visit-to-visit fasting plasma glucose variability is associated with left ventricular adverse remodeling in diabetic patients with STEMI. Cardiovasc Diabetol 2020; 19(1):131.
https://doi.org/10.1186/s12933-020-01112-6
24.Zhang JW, He LJ, Cao SJ, Yang Q, Yang SW, Zhou YJ. Effect of glycemic variability on short term prognosis in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions. Diabetol Metab Syndr 2014; 6:76.
https://doi.org/10.1186/1758-5996-6-76
25.Tsuchida K, Nakamura N, Soda S, Sakai R, Nishida K, Hiroki J, et al. Relationship between glucose fluctuations and ST-segment resolution in patients with ST-elevation acute myocardial infarction. Int Heart J 2017; 58(3):328-34.
https://doi.org/10.1536/ihj.16-250
26.Wu H, Li R, Wang K, Mu D, Chen JZ, Wei X, et al. Predictive value of fasting blood glucose for microvascular obstruction in nondiabetic patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention. Cardiol Res Pract 2020; 2020:8429218.
https://doi.org/10.1155/2020/8429218
27.Wang H, Zhang Y, Shen Z, Fang L, Liu Z, Zhang S. Prognostic value of fasting glucose on the risk of heart failure and left ventricular systolic dysfunction in non-diabetic patients with ST-segment elevation myocardial infarction. Front Med 2021; 15(1):70-8.
https://doi.org/10.1007/s11684-020-0749-x
28.Zhou X, Lei M, Zhou D, Li G, Duan Z, Zhou S, et al. Clinical factors affecting left ventricular end-diastolic pressure in patients with acute ST-segment elevation myocardial infarction. Ann Palliat Med 2020; 9(4):1834-40.
https://doi.org/10.21037/apm.2020.03.22
29.Qin Y, Yan G, Qiao Y, Wang D, Luo E, Hou J, et al. Predictive value of random blood glucose versus fasting blood glucose on in-hospital adverse events in patients with ST-segment elevation acute myocardial infarction. BMC Cardiovasc Disord 2020; 20(1):95.
https://doi.org/10.1186/s12872-020-01394-4

1. Jernberg T, Johanson P, Held C, Svennblad B, Lindback J, Wallentin L. Association between adoption of evidence-based treatment and survival for patients with ST-elevation myocardial infarction. JAMA 2011; 305(16):1677-84.

https://doi.org/10.1001/jama.2011.522

2. Steg PG, James SK, Atar D, Badano LP, Lunqvist CB, Borger MA, et al. ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012; 33(20):2569-619.

https://doi.org/10.1093/eurheartj/ehs215

3. O’Gara PT, Kushner FG, Ascheim DD, Casey Jr DE, Chung MK, de Lamos JA, et al, 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 61(4):e78-e140.

https://doi.org/10.1016/j.jacc.2012.11.019

4. Hartopo AB, Setianto BY, Gharini PP, Dinarti LK. On arrival high blood glucose level is associated with detrimental and fatal hospitalization outcomes for acute coronary syndrome. Cardiol Res 2011; 2(4):160-7.

https://doi.org/10.4021/cr56w

5. Uppalakal B, Karanayil LS. Incidence of metabolic syndrome in patients admitted to medical wards with st elevation myocardial infarction. J Clin Diagn Res 2017; 11(3):OC17-OC20.

https://doi.org/10.7860/JCDR/2017/24803.9481

6. Knudsen EC, Seljeflot I, Abdelnoor M, Eritsland J, Mangschau A, Arnesen H, et al. Abnormal glucose regulation in patients with acute ST-elevation myocardial infarction-a cohort study on 224 patients. Cardiovasc Diabetol 2009; 8:6.

https://doi.org/10.1186/1475-2840-8-6

7. Stratton IM, Adler AI, Neil HA, Matthews DR, Cull CA, Hadden D, et al. Association of glycaemic control with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321(7258):405-12.

https://doi.org/10.1136/bmj.321.7258.405

8. Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycaemia and the risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet 2000; 355(9206):773-8.

https://doi.org/10.1016/S0140-6736(99)08415-9

9. Norhammar A, Tenerz A, Nilsson G, Efendic S, Ryden L, Malmberg K. Glucose metabolism in patients with myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet 2002; 359(9324):2140-4.

https://doi.org/10.1016/S0140-6736(02)09089-X

10. Timmer JR, Hoekstra M, Nijsten MWN, van der Horst ICC, Ottervanger JP, Slingerland RJ, et al. Prognostic value of admission glycosylated hemoglobin and glucose in nondiabetic patients with ST-segment-elevation myocardial infarction treated with percutaneous coronary intervention. Circulation 2011; 124(6):704-11.

https://doi.org/ 10.1161/CIRCULATIONAHA.110.985911

11. O'Sullivan JJ, Conroy RM, Robinson K, Hickey N, Mulcahy R. In-hospital prognosis of patients with fasting hyperglycemia after first myocardial infarction. Diabetes Care 1991; 14(8):758-60.

https://doi.org/10.2337/diacare.14.8.758

12. Malmberg K, Norhammar A, Wedel H, Ryden L. Glycometabolic state at admission: important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction: long-term results from the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study. Circulation 1999; 99(20):2626-32.

https://doi.org/10.1161/01.cir.99.20.2626

13. Malmberg K, Rydén L, Wedel H, Birkeland K, Bootsma A, Dickstein K, et al. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity. Eur Heart J 2005; 26(7):650-61.

https://doi.org/10.1093/eurheartj/ehi199.

14. Hartopo AB, Sukmasari I, Puspitawati I. The utility of point of care test for soluble ST2 in predicting adverse cardiac events during acute care of ST-segment elevation myocardial infarction. Cardiol Res Pract 2018; 2018:3048941.

https://doi.org/10.1155/2018/3048941

15. Hartopo AB, Puspitawati I, Mumpuni H. The ratio of circulating endothelin-1 to endothelin-3 associated with TIMI risk and dynamic TIMI risk score in ST elevation acute myocardial infarction. Can J Physiol Pharmacol 2020; 98(9):637-43.

https://doi.org/10.1139/cjpp-2019-0654

16. Lazzeri C, Valente S, Chiostri M, Picariello C, Gensini GF. Acute glucose dysmetabolism in the early phase of ST-elevation myocardial infarction: the age response. Diab Vasc Dis Res 2010; 7(2):131-7.

https://doi.org/10.1177/1479164109353369

17. Lazzeri C, Valente S, Chiostri M, Picariello C, Gensini GF. In-hospital peak glycemia and prognosis in STEMI patients without earlier known diabetes. Eur J Cardiovasc Prev Rehabil 2010; 17(4):419-23.

https://doi.org/10.1097/HJR.0b013e328335f26f

18. Kewcharoen J, Ali M, Trongtorsak A, Mekraksakit P, Vutthikraivit W, Kanjanauthai S. Admission hyperglycemia is associated with reperfusion failure in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis. Am J Cardiovasc Dis 2021; 11(3):348-59.

19. Liu J, Wang S, Cui C, Cai H, Sun R, Pan W, et al. The association between glucose-related variables and plaque morphology in patients with ST-segment elevated myocardial infarction. Cardiovasc Diabetol 2020; 19(1):109.

https://doi.org/10.1186/s12933-020-01074-9

20. Moura FA, Figueiredo VN, Teles BSBS, Barbosa MA, Pereira LR, Costa APR, et al. Glycosylated hemoglobin is associated with decreased endothelial function, high inflammatory response, and adverse clinical outcome in non-diabetic STEMI patients. Atherosclerosis 2015; 243(1):124-30.

https://doi.org/10.1016/j.atherosclerosis.2015.09.004

21. Tsai JP, Tian J, Wang WYS, Ng ACT. Glycated hemoglobin vs fasting plasma glucose as a predictor of left ventricular dysfunction after ST-elevation myocardial infarction. Can J Cardiol 2015; 31(1):44-9.

https://doi.org/10.1016/j.cjca.2014.10.029

22. Lazzeri C, Valente S, Chiostri M, Picariello C, Attanà P, Gensini GF. The prognostic impact of glycated hemoglobin in diabetic ST-elevation myocardial infarction. Int J Cardiol 2011; 151(2):250-2.

https://doi.org/10.1016/j.ijcard.2011.06.077

23. Yang CD, Shen Y, Ding FH, Yang ZK, Hu J, Shen WF, et al. Visit-to-visit fasting plasma glucose variability is associated with left ventricular adverse remodeling in diabetic patients with STEMI. Cardiovasc Diabetol 2020; 19(1):131.

https://doi.org/10.1186/s12933-020-01112-6

24. Zhang JW, He LJ, Cao SJ, Yang Q, Yang SW, Zhou YJ. Effect of glycemic variability on short term prognosis in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions. Diabetol Metab Syndr 2014; 6:76.

https://doi.org/10.1186/1758-5996-6-76

25. Tsuchida K, Nakamura N, Soda S, Sakai R, Nishida K, Hiroki J, et al. Relationship between glucose fluctuations and ST-segment resolution in patients with ST-elevation acute myocardial infarction. Int Heart J 2017; 58(3):328-34.

https://doi.org/10.1536/ihj.16-250

26. Wu H, Li R, Wang K, Mu D, Chen JZ, Wei X, et al. Predictive value of fasting blood glucose for microvascular obstruction in nondiabetic patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention. Cardiol Res Pract 2020; 2020:8429218.

https://doi.org/10.1155/2020/8429218

27. Wang H, Zhang Y, Shen Z, Fang L, Liu Z, Zhang S. Prognostic value of fasting glucose on the risk of heart failure and left ventricular systolic dysfunction in non-diabetic patients with ST-segment elevation myocardial infarction. Front Med 2021; 15(1):70-8.

https://doi.org/10.1007/s11684-020-0749-x

28. Zhou X, Lei M, Zhou D, Li G, Duan Z, Zhou S, et al. Clinical factors affecting left ventricular end-diastolic pressure in patients with acute ST-segment elevation myocardial infarction. Ann Palliat Med 2020; 9(4):1834-40.

https://doi.org/10.21037/apm.2020.03.22

29. Qin Y, Yan G, Qiao Y, Wang D, Luo E, Hou J, et al. Predictive value of random blood glucose versus fasting blood glucose on in-hospital adverse events in patients with ST-segment elevation acute myocardial infarction. BMC Cardiovasc Disord 2020; 20(1):95.

https://doi.org/10.1186/s12872-020-01394-4



DOI: https://doi.org/10.19106/JMedSci005401202204

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Journal of the Medical Sciences (Berkala Ilmu Kedokteran) by  Universitas Gadjah Mada is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
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