Predicting Mortality Following Acute Myocardial Infarction in Diabetes

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Investigators compared the predictive value of the acute-to-chronic glycemic ratio with glycemia levels obtained at hospital admission.
Investigators compared the predictive value of the acute-to-chronic glycemic ratio with glycemia levels obtained at hospital admission.

The acute-to-chronic (A/C) glycemic ratio provided better prognostic insight with regard to in-hospital mortality and morbidity outcomes compared with glycemia levels at hospital admission in patients with diabetes who had an acute myocardial infarction (AMI), according to prospective findings published in Diabetes Care.

Investigators examined outcomes in consecutive patients who had AMI with ST-elevation MI (n=747) and non-ST-elevation MI (n=806) who were admitted to a single center in Italy. A total of 417 (27%) patients had diabetes at hospital admission.

Of the total study population, 583 (37%) had acute hyperglycemia when a cutoff of 144 mg/dL was considered and 233 (15%) had acute hyperglycemia when a cutoff of 198 mg/dL was considered.

Investigators compared the predictive value of the A/C glycemic ratio with glycemia levels obtained at hospital admission. A combination of acute pulmonary edema, cardiogenic shock, and in-hospital mortality comprised the primary end point.

Increasing A/C glycemic ratios in the first, second, and third A/C glycemic ratio tertiles resulted in parallel increases in the rates of the primary end point (5%, 8%, and 20%, respectively; P <.0001).

After adjusting for potential confounders, the A/C glycemic ratio was found to be a major independent predictor of troponin I peak value (P <.03) in all 3 tertiles and an independent predictor of the primary end point (net reclassification improvement 27%; 95% CI, 14%-40%; P <.001) in patients with diabetes.

Overall, the A/C glycemic ratio provided the greatest prognostic power for the primary end point in the entire population (net reclassification improvement 12%; 95% CI, 4%-20%; P =.003).

Because participants in this study were treated at a single institution and most underwent percutaneous coronary intervention, the findings from this study may not be applicable to population groups in other geographic regions who receive alternative forms of care. In addition, the investigators were unable to establish a causal relationship between plasma glucose and patient outcomes because of the study's observational nature.

Compared with admission glycemia, the A/C glycemic ratio “may identify true stress hyperglycemia, which has been associated with larger infarct size and worse in-hospital outcome” in hospitalized patients with diabetes who have chronically elevated glycemic levels.

Reference

Marenzi G, Cosentino N, Milazzo V, et al. Prognostic value of the acute-to-chronic glycemic ratio at admission in acute myocardial infarction: prospective study [published online January 30, 2018]. Diabetes Care. doi:10.2337/dc17-1732

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