Impact of glycemic gap on 30-day adverse outcomes in patients with acute ST-segment elevation myocardial infarction

• Published in: Atherosclerosis Vol. 360; pp. 34 - 41
• Main Authors: Wu, Shuang, Yang, Yan-Min, Zhu, Jun, Xu, Wei, Wang, Lu-Lu, Lyu, Si-Qi, Wang, Juan, Shao, Xing-Hui, Zhang, Han
• Format: Journal Article
• Language: English
• Published: Ireland 01.11.2022
• Subjects: Arrhythmias, Cardiac; Blood Glucose - analysis; Diabetes Mellitus - diagnosis; Diabetes Mellitus - epidemiology; Glycated Hemoglobin - analysis; Humans; Hyperglycemia; Percutaneous Coronary Intervention - adverse effects; Prognosis; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - therapy; All-cause mortality; ST-segment elevation myocardial infarction; Major adverse cardiovascular events; Stress-induced hyperglycemia; Glycemic gap
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2022.10.003

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 GAP , 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. A total of 4952 patients with acute STEMI were included in the final analysis, and they were divided into four groups according to GAP 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. At 30 days of follow-up, 324 (6.5%) deaths and 569 (11.5%) MACEs occurred. With the elevation of GAP , 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 GAP was superior to admission blood glucose (ABG) and GAP (defined as the difference between ABG and ADAG) to detect adverse outcomes. Multivariate Cox regression analysis revealed that elevated GAP 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 GAP significantly improved risk stratification for all-cause mortality and MACEs by 21.6% and 19.8%, respectively. 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.