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Ning L, He C, Lu C, Huang W, Zeng T, Su Q. Association between basal metabolic rate and cardio-metabolic risk factors: Evidence from a Mendelian Randomization study. Heliyon 2024; 10:e28154. [PMID: 38590845 PMCID: PMC10999873 DOI: 10.1016/j.heliyon.2024.e28154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/10/2024] Open
Abstract
Background Cardio-metabolic risk factors play a crucial role in the development of cardiovascular and metabolic diseases. Basal metabolic rate (BMR) is a fundamental physiological parameter that affects energy expenditure and might contribute to variations in these risk factors. However, the exact relationship between BMR and cardio-metabolic risk factors has remained unclear. Methods We employed Mendelian Randomization (MR) analysis to explore the association between BMR (N: 534,045) and various cardio-metabolic risk factors, including body mass index (BMI, N: 681,275), fasting glucose (N: 200,622), high-density lipoprotein (HDL) cholesterol (N = 403,943), low-density lipoprotein (LDL) cholesterol (N = 431,167), total cholesterol (N: 344,278), and triglycerides (N: 441,016), C-reactive protein (N: 436,939), waist circumference (N: 232,101), systolic blood pressure (N: 810,865), diastolic blood pressure (N: 810,865), glycated haemoglobin (N: 389,889), and N-terminal prohormone brain natriuretic peptide (N: 21,758). We leveraged genetic variants strongly associated with BMR as instrumental variables to investigate potential causal relationships, with the primary analysis using the Inverse Variance Weighted (IVW) method. Results Our MR analysis revealed compelling evidence of a causal link between BMR and specific cardio-metabolic risk factors. Specifically, genetically determined higher BMR was associated with an increased BMI (β = 0.7538, 95% confidence interval [CI]: 0.6418 to 0.8659, p < 0.001), lower levels of HDL cholesterol (β = -0.3293, 95% CI: 0.4474 to -0.2111, p < 0.001), higher levels of triglycerides (β = 0.1472, 95% CI: 0.0370 to 0.2574, p = 0.0088), waist circumference (β = 0.4416, 95% CI: 0.2949 to 0.5883, p < 0.001), and glycated haemoglobin (β = 0.1037, 95% CI: 0.0080 to 0.1995, p = 0.0377). However, we did not observe any significant association between BMR and fasting glucose, LDL cholesterol, total cholesterol, C-reactive protein, systolic blood pressure, diastolic blood pressure, or N-terminal prohormone brain natriuretic peptide (all p-values>0.05). Conclusion This MR study provides valuable insights into the relationship between BMR and cardio-metabolic risk factors. Understanding the causal links between BMR and these factors could have important implications for the development of targeted interventions and therapies.
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Affiliation(s)
- Limeng Ning
- Department of Cardiology, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, No. 85 Hedi Road, Nanning, Guangxi, 530021, China
| | - Changjing He
- Pediatric surgery, Affiliated Hospital of Youjiang Medical University for Nationalities, Youjiang Medical University for Nationalities, Baise, China
- Health Management Service Center, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, No.85 Hedi Road, Nanning, Guangxi, 530021, China
- Guangxi Clinical Medical Research Center for Hepatobiliary Diseases, China
- Guangxi Zhuang Autonomous Region Engineering Research Center for Biomaterials in Bone and Joint Degenerative Diseases, China
- Guangxi Key Laboratory for Preclinica1 and Translational Research on Bone and Joint Degenerative Diseases, China
- Guangxi Key Laboratory of Molecular Pathology in Hepatobiliary Diseases, China
- Guangxi Key Laboratory of Clinical Cohort Research on Bone and Joint Degenerative Disease, China
- Guangxi Key Laboratory of Medical Research Basic Guarantee for Immune-Related Disease Research, China
- Guangxi Key Laboratory for Biomedical Material Research, China
- Key Laboratory of Research on Prevention and Control of High Incidence Diseases in Western Guangxi, China
- Key Laboratory of Molecular Pathology in Tumors of Guangxi, China
- Key Laboratory of Research on Clinical Molecular Diagnosis for High Incidence Diseases in Western Guangxi, China
- Baise Key Laboratory of Mo1ecular Pathology in Tumors, China
- Baise Key Laboratory for Metabolic Diseases, China
- Baise Key Laboratory for Research and Deve1opment on Clinical Mo1ecular Diagnosis for High-Incidence Diseases, China
- Key Laboratory of the Bone and Joint Degenerative Diseases, China
- Laboratory of the Atherosclerosis and Ischemic Cardiovascular Diseases, China
- Life Science and C1inical Medicine Research Center, China
- Key Laboratory of Clinical Diagnosis and Treatment Research of High Incidence Diseases in Guangxi, China
| | - Chunliu Lu
- Health Management Service Center, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, No.85 Hedi Road, Nanning, Guangxi, 530021, China
| | - Wanzhong Huang
- Department of Cardiology, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, No. 85 Hedi Road, Nanning, Guangxi, 530021, China
| | - Ting Zeng
- Health Management Service Center, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, No. 85 Hedi Road, Nanning, Guangxi, 530021, China
| | - Qiang Su
- Department of Cardiology, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, No. 85 Hedi Road, Nanning, Guangxi, 530021, China
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Cui K, Fu R, Yang J, Xu H, Yin D, Song W, Wang H, Zhu C, Feng L, Wang Z, Wang Q, Lu Y, Dou K, Yang Y. The impact of fasting stress hyperglycemia ratio, fasting plasma glucose and hemoglobin A1c on in-hospital mortality in patients with and without diabetes: findings from the China acute myocardial infarction registry. Cardiovasc Diabetol 2023; 22:165. [PMID: 37403082 DOI: 10.1186/s12933-023-01868-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/27/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Stress hyperglycemia was positively associated with poor prognosis in individuals with acute myocardial infarction (AMI). However, admission glucose and stress hyperglycemia ratio (SHR) may not be the best indicator of stress hyperglycemia. We performed this study to evaluate the comparative prognostic value of different measures of hyperglycemia (fasting SHR, fasting plasma glucose [FPG], and hemoglobin A1c [HbA1c]) for in-hospital mortality in AMI patients with or without diabetes. METHODS In this prospective, nationwide, multicenter China Acute Myocardial Infarction (CAMI) registry, 5,308 AMI patients including 2081 with diabetes and 3227 without diabetes were evaluated. Fasting SHR was calculated using the formula [(first FPG (mmol/l))/(1.59×HbA1c (%)-2.59)]. According to the quartiles of fasting SHR, FPG and HbA1c, diabetic and non-diabetic patients were divided into four groups, respectively. The primary endpoint was in-hospital mortality. RESULTS Overall, 225 (4.2%) patients died during hospitalization. Individuals in quartile 4 had a significantly higher rate of in-hospital mortality compared with those in quartile 1 in diabetic cohort (9.7% vs. 2.0%; adjusted odds ratio [OR] 4.070, 95% CI 2.014-8.228) and nondiabetic cohort (8.8% vs. 2.2%; adjusted OR 2.976, 95% CI 1.695-5.224). Fasting SHR was also correlated with higher in-hospital mortality when treated as a continuous variable in diabetic and nondiabetic patients. Similar results were observed for FPG either as a continuous variable or a categorical variable. In addition, fasting SHR and FPG, rather than HbA1c, had a moderate predictive value for in-hospital mortality in patients with diabetes (areas under the curve [AUC] for fasting SHR: 0.702; FPG: 0.689) and without diabetes (AUC for fasting SHR: 0.690; FPG: 0.693). The AUC for fasting SHR was not significantly different from that of FPG in diabetic and nondiabetic patients. Moreover, adding fasting SHR or FPG to the original model led to a significant improvement in C-statistic regardless of diabetic status. CONCLUSIONS This study indicated that, in individuals with AMI, fasting SHR as well as FPG was strongly associated with in-hospital mortality regardless of glucose metabolism status. Fasting SHR and FPG might be considered as a useful marker for risk stratification in this population. TRIAL REGISTRATION ClinicalTrials.gov NCT01874691.
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Affiliation(s)
- Kongyong Cui
- Cardiometabolic Medicine Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Rui Fu
- Cardiometabolic Medicine Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jingang Yang
- Coronary Heart Disease Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Haiyan Xu
- Coronary Heart Disease Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Dong Yin
- Cardiometabolic Medicine Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Weihua Song
- Cardiometabolic Medicine Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Hongjian Wang
- Cardiometabolic Medicine Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Chenggang Zhu
- Cardiometabolic Medicine Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Lei Feng
- Cardiometabolic Medicine Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Zhifang Wang
- Department of Cardiology, Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical University, Xinxiang, Henan Province, China
| | - Qingsheng Wang
- Department of Cardiology, Qinhuangdao First Hospital, Qinhuangdao, Hebei Province, China
| | - Ye Lu
- Medical Research & Biometrics Center, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kefei Dou
- Cardiometabolic Medicine Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China.
| | - Yuejin Yang
- Coronary Heart Disease Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China.
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Deng Q, Hou J, Deng X, Zhong Z. Association of serum laboratory parameters with periprocedural myocardial infarction after a primary percutaneous coronary intervention. Perfusion 2023; 38:393-400. [PMID: 35038275 DOI: 10.1177/02676591211057502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Periprocedural myocardial infarction (PMI) is one of the mortality-related complications of percutaneous coronary intervention (PCI) and significantly affects short- and long-term adverse outcomes and immediate cardiovascular events. Our present study aimed to evaluate the association of preprocedural serum laboratory parameters and PMI in patients who received primary PCI and attempted to provide detailed data on the predictors of PCI-related PMI. METHODS A total of 1184 consecutive coronary artery disease (CAD) patients who received primary and elective PCI between July 2015 and June 2017 were included and divided into control group and PMI group. The data of serum laboratory parameters were collected from the electronic database of Meizhou People's Hospital. RESULTS The results indicated that preprocedural fasting blood glucose were higher in PMI group compared with the control group (p < .001). Patients with prior hyperlipidemia were more likely to have experienced PCI-related PMI (p = .018) and the preprocedural level of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, apolipoprotein B (Apo B), and LDL-C/high density lipoprotein cholesterol (HDL-C) were significantly enhanced in PMI group (p < .001). Multivariate regression analysis revealed that preprocedural fasting blood glucose > 6.11 mmol/L (p < .001, OR = 1.949, 95% CI: 1.444-2.630) and LDL-C levels ≥130 mg/dL (p = .005, OR = 1.941, 95% CI: 1.217-3.098) independently predicted PCI-related PMI. CONCLUSION Our results indicated preprocedural fasting blood glucose >6.11 mmol/L and LDL-C levels ≥130 mg/dL may be useful predictors for PCI-related PMI. The study may provide a detailed data on the predictors of PCI-related PMI.
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Affiliation(s)
- Qiaoting Deng
- Research Experimental Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou, PR China.,Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, PR China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, PR China
| | - Jingyuan Hou
- Research Experimental Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou, PR China.,Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, PR China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, PR China
| | - Xunwei Deng
- Research Experimental Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou, PR China.,Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, PR China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, PR China
| | - Zhixiong Zhong
- Research Experimental Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou, PR China.,Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, PR China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, PR China.,Department of Cardiovascular Diseases Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou, PR China
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Brennan S, Esposito S, Abdelaziz MIM, Martin CA, Makwana S, Sims MW, Squire IB, Sharma P, Chadwick AE, Rainbow RD. Selective protein kinase C inhibition switches time-dependent glucose cardiotoxicity to cardioprotection. Front Cardiovasc Med 2022; 9:997013. [PMID: 36158799 PMCID: PMC9489859 DOI: 10.3389/fcvm.2022.997013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/15/2022] [Indexed: 12/03/2022] Open
Abstract
Hyperglycaemia at the time of myocardial infarction has an adverse effect on prognosis irrespective of a prior diagnosis of diabetes, suggesting glucose is the damaging factor. In ex vivo models of ischaemia, we demonstrated that deleterious effects of acutely elevated glucose are PKCα/β-dependent, and providing PKCα/β are inhibited, elevated glucose confers cardioprotection. Short pre-treatments with high glucose were used to investigate time-dependent glucose cardiotoxicity, with PKCα/β inhibition investigated as a potential mechanism to reverse the toxicity. Freshly isolated non-diabetic rat cardiomyocytes were exposed to elevated glucose to investigate the time-dependence toxic effects. High glucose challenge for >7.5 min was cardiotoxic, proarrhythmic and lead to contractile failure, whilst cardiomyocytes exposed to metabolic inhibition following 5-min high glucose, displayed a time-dependent protection lasting ∼15 min. This protection was further enhanced with PKCα/β inhibition. Cardioprotection was measured as a delay in contractile failure and KATP channel activation, improved contractile and Ca2+ transient recovery and increased cell survival. Finally, the effects of pre-ischaemic treatment with high glucose in a whole-heart coronary ligation protocol, where protection was evident with PKCα/β inhibition. Selective PKCα/β inhibition enhances protection suggesting glycaemic control with PKC inhibition as a potential cardioprotective therapeutics in myocardial infarction and elective cardiac surgery.
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Affiliation(s)
- Sean Brennan
- Department of Cardiovascular, Metabolic Medicine and Liverpool Centre for Cardiovascular Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- *Correspondence: Sean Brennan,
| | - Simona Esposito
- Department of Cardiovascular, Metabolic Medicine and Liverpool Centre for Cardiovascular Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Cardiovascular Sciences, University of Leicester, Glenfield General Hospital, Leicester, United Kingdom
| | - Muhammad I. M. Abdelaziz
- Department of Cardiovascular, Metabolic Medicine and Liverpool Centre for Cardiovascular Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Christopher A. Martin
- Department of Cardiovascular Sciences, University of Leicester, Glenfield General Hospital, Leicester, United Kingdom
| | - Samir Makwana
- Department of Cardiovascular Sciences, University of Leicester, Glenfield General Hospital, Leicester, United Kingdom
| | - Mark W. Sims
- Department of Cardiovascular Sciences, University of Leicester, Glenfield General Hospital, Leicester, United Kingdom
| | - Iain B. Squire
- Department of Cardiovascular Sciences, University of Leicester, Glenfield General Hospital, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Glenfield General Hospital, Leicester, United Kingdom
| | - Parveen Sharma
- Department of Cardiovascular, Metabolic Medicine and Liverpool Centre for Cardiovascular Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Amy E. Chadwick
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, Liverpool, United Kingdom
| | - Richard D. Rainbow
- Department of Cardiovascular, Metabolic Medicine and Liverpool Centre for Cardiovascular Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Richard D. Rainbow,
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Zheng W, Huang X, Zhao X, Gong W, Wang X, Nie S. Impact of Stress Hyperglycemia on the Timing of Complete Revascularization in Non-diabetes Patients with ST Elevation Myocardial Infarction and Multivessel Disease. Angiology 2022; 74:587-595. [PMID: 35854437 DOI: 10.1177/00033197221115555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Stress hyperglycemia (SHG) is related to an increased risk of mortality in diabetic patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). However, data are limited in non-diabetic patients especially in patients with multivessel disease (MVD). Methods and Results: In this retrospective study, 742 non-diabetic patients with STEMI and MVD were divided into SHG group and non-SHG group. The overall incidence of SHG was 24.9%. The incidence of no-reflow (NR) phenomenon (18.4% vs 11.8%; P = .024) and in-hospital mortality (1.6% vs .2%; P = .020) in SHG group were significantly higher than those in non-SHG group. SHG was associated with 30-day MACE (hazard ratio, 4.265; 95% confidence interval (CI), 1.354-13.439; P = .013), but not 1-year. Multivariate logistic analysis showed that SHG (odds ratio: 1.691, 95% CI: 1.072-2.667, P = .024) was an independent predictor of NR. If complete revascularization (CR) was performed during PPCI, the incidence of NR would be significantly higher. Conclusion: In non-diabetic patients with STEMI and MVD, SHG is associated with increased SF-NR and short-term adverse events, and CR during PPCI further increases the risk of NR.
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Affiliation(s)
- Wen Zheng
- Department of Cardiology 12667Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xin Huang
- Department of Cardiology, 117968Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xuedong Zhao
- Department of Cardiology 12667Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Gong
- Department of Cardiology 12667Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiao Wang
- Department of Cardiology 12667Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shaoping Nie
- Department of Cardiology 12667Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Short and long-term prognosis of admission hyperglycemia in patients with and without diabetes after acute myocardial infarction: a retrospective cohort study. Cardiovasc Diabetol 2022; 21:114. [PMID: 35739511 PMCID: PMC9229884 DOI: 10.1186/s12933-022-01550-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Admission hyperglycemia is associated with poor prognosis in patients with acute myocardial infarction (AMI), but the effects of baseline diabetes status on this association remain elusive. We aim to investigate the impact of admission hyperglycemia on short and long-term outcomes in diabetic and non-diabetic AMI patients. METHODS In this retrospective cohort study, 3330 patients with regard to first-time AMI between July 2012 and July 2020 were identified. Participants were divided into two groups according to diabetes status (1060 diabetic patients and 2270 non-diabetic patients). Thereafter, they were divided into four groups according to diabetes status-specific cutoff values of fasting blood glucose (FBG) identified by restricted cubic spline. Short-term outcomes included in-hospital death and cardiac complications. Long-term outcomes were all-cause mortality and major adverse cardiovascular events (MACE). Inverse probability of treatment weighting (IPTW) was conducted to adjust for baseline differences among the groups, followed by a weighted Cox proportional hazards regression analysis to calculate hazard ratios and 95% confidence intervals for all-cause mortality associated with each FBG category. Subgroup analysis and sensitivity analysis were performed to test the robustness of our findings. RESULTS During a median follow-up of 3.2 years, 837 patients died. There was a significant interaction between diabetes status and FBG levels for all-cause mortality during long-term follow-up (p-interaction < 0.001). Moreover, restricted cubic spline curves for the association between FBG and all-cause mortality followed a J shape in patients with diabetes and a non-linear in patients without diabetes. Kaplan-Meier analysis demonstrated greater survival in non-hyperglycemia patients compared to hyperglycemia patients for both diabetic and non-diabetic patients groups. Survival of hyperglycemia patients without diabetes greater than in hyperglycemia patients with diabetes. In the weighted Multivariable cox analysis, admission hyperglycemia predicted higher short and long-term mortality. Subgroup analysis and sensitivity analysis showed the robustness of the results. CONCLUSIONS The inflection points of FBG level for poor prognosis were 5.60 mmol/L for patients without diabetes and 10.60 mmol/L for patients with diabetes. Admission hyperglycemia was identified as an independent predictor of worse short and long-term outcomes in AMI patients, with or without diabetes. These findings should be explored further.
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Cui C, Zhou M, Cheng L, Ye T, Zhang Y, Zhu F, Li S, Jiang X, Chen Q, Qi L, Chen X, Yang S, Cai L. Admission hyperglycemia as an independent predictor of long-term prognosis in acute myocardial infarction patients without diabetes: A retrospective study. J Diabetes Investig 2021; 12:1244-1251. [PMID: 33249775 PMCID: PMC8264390 DOI: 10.1111/jdi.13468] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/23/2020] [Accepted: 11/21/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS/INTRODUCTION The predictive value of admission hyperglycemia in the long-term prognosis of acute myocardial infarction patients is still controversial. We aimed to investigate this value based on the diabetes status. MATERIALS AND METHODS We carried out a multicenter, retrospective study of 1,288 acute myocardial infarction patients enrolled in 11 hospitals between March 2014 and June 2019 in Chengdu, China. The patients were classified into those with diabetes and those without diabetes, each was further divided into: hyperglycemia and non-hyperglycemia subgroups, according to the optimal cut-off value of the blood glucose to predict all-cause mortality during follow up. The end-points were all-cause death and major adverse cardiovascular and cerebrovascular events, including all-cause death, non-fatal myocardial infarction, vessel revascularization and non-fatal stroke. RESULTS In the follow-up period of 15 months, we observed 210 (16.3%), 6 (0.5%), 57 (4.4%) and 34 (2.6%) cases of death, non-fatal myocardial infarction, revascularization and non-fatal stroke, respectively. The optimal cut-off values of admission blood glucose for patients with diabetes and patients without diabetes to predict all-cause mortality during follow up were 14.80 and 6.77 mmol/L, respectively. We divided patients with diabetes (n = 331) into hyperglycemia (n = 92) and non-hyperglycemia (n = 239), and patients without diabetes (n = 897) into hyperglycemia (n = 425) and non-hyperglycemia (n = 472). The cumulative rates of all-cause death and major adverse cardiovascular and cerebrovascular events among the patients in each hyperglycemia group was higher than that in the corresponding non-hyperglycemia group (P < 0.001). In patients without diabetes, admission hyperglycemia was an independent predictor of all-cause mortality and major adverse cardiovascular and cerebrovascular events. CONCLUSION Admission hyperglycemia was an independent predictor for long-term prognosis in acute myocardial infarction patients without diabetes.
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Affiliation(s)
- Cai‐yan Cui
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Ming‐gang Zhou
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Lian‐chao Cheng
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Tao Ye
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Yu‐mei Zhang
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Feng Zhu
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Si‐yi Li
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Xing‐lin Jiang
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Qiang Chen
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Ling‐yao Qi
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Xu Chen
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Si‐qi Yang
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Lin Cai
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
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Jiao X, Guo H, Zhang G, Yin X, Li H, Chen Y. In-hospital fasting hyperglycemia and increased risk of mortality after acute coronary syndrome: a systematic overview and meta-analysis. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-020-00850-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Li M, Chen G, Feng Y, He X. Stress Induced Hyperglycemia in the Context of Acute Coronary Syndrome: Definitions, Interventions, and Underlying Mechanisms. Front Cardiovasc Med 2021; 8:676892. [PMID: 34055942 PMCID: PMC8149624 DOI: 10.3389/fcvm.2021.676892] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/19/2021] [Indexed: 01/08/2023] Open
Abstract
Elevation of glucose level in response to acute coronary syndrome (ACS) has been recognized as stress induced hyperglycemia (SIH). Plenty of clinical studies have documented that SIH occurs very common in patients hospitalized with ACS, even in those without previously known diabetes mellitus. The association between elevated blood glucose levels with adverse outcome in the ACS setting is well-established. Yet, the precise definition of SIH in the context of ACS remains controversial, bringing confusions about clinical management strategy. Several randomized trials aimed to evaluate the effect of insulin-based therapy on outcomes of ACS patients failed to demonstrate a consistent benefit of intensive glucose control. Mechanisms underlying detrimental effects of SIH on patients with ACS are undetermined, oxidative stress might play an important role in the upstream pathways leading to subsequent harmful effects on cardiovascular system. This review aims to discuss various definitions of SIH and their values in predicting adverse outcome in the context of ACS, as well as the effect of intensive glucose control on clinical outcome. Finally, a glimpse of the underlying mechanisms is briefly discussed.
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Affiliation(s)
- Mingmin Li
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guo Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xuyu He
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Kilic A, Baydar O. Relationship Between Fasting Glucose, HbA 1c Levels, and the SYNTAX Score 2 in Patients With Non-ST-Elevation Myocardial Infarction. Angiology 2021; 73:177-181. [PMID: 33960202 DOI: 10.1177/00033197211014678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We evaluated if admission glycosylated hemoglobin (HbA1c) and fasting glucose levels are correlated with the severity of coronary artery disease (CAD) in non-ST-elevation myocardial infarction (NSTEMI), nondiabetic, patients. Coronary artery disease severity, according to the anatomical synergy between percutaneous coronary intervention (PCI) with taxus and cardiac surgery (SYNTAX) score 2 (SSII), was retrospectively evaluated in 359 nondiabetic patients hospitalized with NSTEMI who underwent coronary angiography. Glucose intolerance was assessed by serum fasting glucose and HbA1c levels. We stratified patients according to tertiles of SSII (≤21.5, 21.5-30.6, and ≥30.6). These score ranges were defined as SSII low, SSII mid, and SSII high, respectively. The average age of the patients was 57.1 ± 10.9 years; 189 (52.1%) patients were males. The average fasting glucose was 114 ± 52 mg/dL, HbA1c was 5.8% ± 0.9%, and SSII was 18.9 ± 10.3. A stronger correlation was found between HbA1c and SSII than fasting glucose and SSII (r1 = 0.901, P < .001, r2 = 0.378, P < .001, respectively), and HbA1c level and hypertension were independent risk factors for SSII high (odds ratio [OR]: 2.2 (95% CI: 0.5-9.0, P < .001; OR: 1.1 (1.0-1.3), P = .007, respectively). In conclusion, in nondiabetic patients with NSTEMI, HbA1c levels correlated with CAD severity as measured by the SSII.
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Affiliation(s)
- Alparslan Kilic
- Department of Cardiology, 52979Koc University Hospital, Istanbul, Turkey
| | - Onur Baydar
- Department of Cardiology, 52979Koc University Hospital, Istanbul, Turkey
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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 2020; 15:70-78. [PMID: 32519296 DOI: 10.1007/s11684-020-0749-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 12/18/2019] [Indexed: 01/11/2023]
Abstract
Recent studies have shown that acute blood glucose elevation in patients with ST-segment elevation myocardial infarction (STEMI) suggests a poor prognosis. To investigate the effect of fasting blood glucose (FBG) on the risk of heart failure (HF) and left ventricular systolic dysfunction (LVSD) in non-diabetic patients undergoing primary percutaneous coronary intervention (PCI) for acute STEMI, we retrospectively recruited consecutive non-diabetic patients who underwent primary PCI for STEMI in our hospital from February 2003 to March 2015. The patients were divided into two groups according to the FBG level. A total of 623 patients were recruited with an age of 61.3 ± 12.9 years, of whom 514 (82.5%) were male. The HF risk (odds ratio 3.401, 95% confidence interval (CI) 2.144-5.395, P < 0.001) was significantly increased in patients with elevated FBG than those with normal FBG. Elevated FBG was also independently related to LVSD (β 1.513, 95%CI 1.282-1.785, P < 0.001) in a multiple logistics regression analysis. In conclusion, elevated FBG was independently associated with 30-day HF and LVSD risk in non-diabetic patients undergoing primary PCI for STEMI.
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Lee W, Kim SH, Yoon CH, Suh JW, Cho YS, Youn TJ, Chae IH. Impact of Long-term Glycosylated Hemoglobin in Patients with Acute Myocardial Infarction: a retrospective cohort study. Sci Rep 2020; 10:6726. [PMID: 32317703 PMCID: PMC7174312 DOI: 10.1038/s41598-020-63802-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/06/2020] [Indexed: 01/21/2023] Open
Abstract
Little clinical evidence supports the strict implementation of glycemic control for diabetic patients with AMI. We aimed to demonstrate the effect of long-term glycemic control on mortality in patients with diabetes mellitus after acute myocardial infarction (AMI). Eight hundred and twenty-four consecutive diabetic patients were divided into three groups according to the mean hemoglobin (HbA1c) value: <6% (group A), ≥6% to <7.5% (group B), and ≥7.5% (group C). The best long-term mortality outcome was observed in Group B, followed by groups C and A. Groups B and C were further compared in-depth because the baseline characteristics of group A differed significantly. A Cox regression analysis indicated that Group C was associated with an adjusted hazard ratio (HR) of 1.55 [95% confidence interval (CI): 1.02-2.34, P = 0.038]. An inverse probability of treatment weight analysis was performed to compare groups B and C. Group C had significantly higher mortality, compared to group B (adjusted HR: 1.58; 95% CI: 1.21-2.06, P < 0.001). In conclusion, Glycemic status was associated with the long-term survival outcome in diabetic patients after AMI. However, further study is needed to prove whether HbA1c-targeted glycemic control can effectively improve survival after AMI.
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Affiliation(s)
- Wonjae Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Sun-Hwa Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Chang-Hwan Yoon
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea.
| | - Jung-Won Suh
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Young-Seok Cho
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Tae-Jin Youn
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
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Chattopadhyay S, George A, John J, Sathyapalan T. Newly diagnosed abnormal glucose tolerance determines post-MI prognosis in patients with hospital related hyperglycaemia but without known diabetes. J Diabetes Complications 2020; 34:107518. [PMID: 31924528 DOI: 10.1016/j.jdiacomp.2019.107518] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/20/2019] [Accepted: 12/28/2019] [Indexed: 01/16/2023]
Abstract
AIMS Investigate if abnormal glucose tolerance (AGT) affects post-myocardial infarction (MI) prognosis in patients with hospital-related hyperglycaemia (HRH) but without known diabetes mellitus (KDM). METHODS Post-MI survivors without KDM underwent pre-discharge oral glucose tolerance test. Cardiovascular death and non-fatal re-infarction (MACE) were recorded. We compare the ability of admission (APG), fasting (FPG) and 2 h post-load (2 h-PG) plasma glucose to predict MACE in patients with (HRH) and without HRH (NoHRH). RESULTS 50.2% and 73% of NoHRH and HRH had AGT respectively. MACE occurred in 19.5% and 18.1% in HRH and NoHRH groups. MACE-free survival was lower in patient with AGT in both groups (NoHRH: HR 1.82, 95% CI 1.19-2.78, p = 0.005; HRH: HR 2.48, 95% CI 1.24-4.96, p = 0.010). AGT predicted MACE-free survival (NoHRH: HR 1.60, 95% CI 1.02-2.51, p = 0.042; HRH: HR 3.09, 95% CI 1.07-8.94, p = 0.037). 2 h-PG, but not FPG or APG, independently predicted MACE free survival (NoHRH: HR 1.17, 95% CI 1.07-1.27, p ≤0.001 and HRH: HR 1.18, 95% CI 1.03-1.37, p = 0.020). Addition of AGT and 2 h-PG, not FPG or APG, improved net reclassification of events in both groups. CONCLUSION Post-MI prognosis is worse with AGT irrespective of presence of HRH. 2 h-PG, predicts prognosis in HRH and NoHRH groups.
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Affiliation(s)
| | - Anish George
- Department of Cardiology, Scunthorpe General Hospital, Cliff Gardens, Scunthorpe, UK
| | - Joseph John
- Department of Cardiology, Castle Hill Hospital, Kingston upon Hull, UK.
| | - Thozhukat Sathyapalan
- Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, University of Hull, Kingston upon Hull, UK.
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Qin Y, Yan G, Qiao Y, Wang D, Luo E, Hou J, Tang C. 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; 20:95. [PMID: 32103724 PMCID: PMC7045631 DOI: 10.1186/s12872-020-01394-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/17/2020] [Indexed: 01/08/2023] Open
Abstract
Background We aim to find out the relationship between random blood glucose (RBG), fasting blood glucose (FBG) and in-hospital adverse events in ST-segment elevation acute myocardial infarction (STEMI) patients. We evaluate and compare the predictive value of RBG and FBG on in-hospital adverse events, and give an appropriate cut-off value of RBG and FBG. Method A retrospective study enrolled 958 consecutive AMI patients undergoing emergency coronary angiography at Zhongda Hospital were enrolled from January 1, 2016, to December 31, 2018 was performed. RBG and FBG, baseline data and adverse events were recorded. Major adverse cardiovascular and cerebrovascular events (MACCE) were defined as death, nonfatal recurrent myocardial infarction and stroke. Other adverse events included malignant arrhythmia, cardiac shock and hemorrhage. Patients with RBG > 11.1 mmol/L were divided into elevated RBG group. Patients with FBG > 6.1 mmol/L were divided into elevated FBG group. The incidence of in-hospital adverse events were compared in elevated RBG/FBG group and the control group. ROC curve was used to evaluate the predictive value of RBG and FBG on in-hospital adverse events. Result The incidence of death, hemorrhage, cardiac shock and malignant arrhythmia significantly increases in elevated RBG and FBG group. Binary logistic regression showed that age, hypertension, diabetes, FBG and RBG were independent risk factors for in-hospital adverse events in STEMI patients. The AUC and 95% CI of RBG and FBG in predicting death of AMI patients were 0.789, 0.759~0.816; 0.810, 0.783~0.835, respectively. The cut-off values were 13.82 and 7.35 mmol/L. RBG and FBG also had fine predictive value on cardiac shock and malignant arrhythmia, no statistical difference was found in the predictive value on in-hospital adverse events (P = 0.462, P = 0.570, P = 0.694). Conclusion Incidence of in-hospital adverse events significantly increases in AMI patients combined with elevated RBG or FBG. Both RBG and FBG were independent risk factors for in-hospital adverse events, they had good value on predicting in-hospital adverse events and there was no statistical difference in their predictive value.
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Affiliation(s)
- Yuhan Qin
- Medical school of Southeast University, Nanjing, 210009, People's Republic of China
| | - Gaoliang Yan
- Department of Cardiology, Zhongda Hospital affiliated to Southeast University, Nanjing, 210009, People's Republic of China
| | - Yong Qiao
- Department of Cardiology, Zhongda Hospital affiliated to Southeast University, Nanjing, 210009, People's Republic of China
| | - Dong Wang
- Department of Cardiology, Zhongda Hospital affiliated to Southeast University, Nanjing, 210009, People's Republic of China
| | - Erfei Luo
- Medical school of Southeast University, Nanjing, 210009, People's Republic of China
| | - Jiantong Hou
- Medical school of Southeast University, Nanjing, 210009, People's Republic of China
| | - Chengchun Tang
- Department of Cardiology, Zhongda Hospital affiliated to Southeast University, Nanjing, 210009, People's Republic of China.
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Diabetes Mellitus and Acute Myocardial Infarction: Impact on Short and Long-Term Mortality. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1307:153-169. [PMID: 32020518 DOI: 10.1007/5584_2020_481] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Diabetes mellitus (DM) is an important risk factor for acute myocardial infarction (AMI) and a frequent co-morbidity in patients hospitalized with AMI, being present in about 30% of cases. Although current treatment of AMI has considerably improved survival in both patients with and without DM, the presence of DM still doubles the case fatality rate during both the acute phase of AMI and at long-term follow-up. This higher mortality risk of DM patients strongly indicates a particular need for better treatment options in these patients and suggests that intensive medical treatment, prolonged surveillance, and stringent control of other risk factors should be carefully pursued and maintained for as long as possible in them.In this review, we will focus on the close association between DM and in-hospital and long-term mortality in AMI patients. We will also aim at providing current evidence on the mechanisms underlying this association and on emerging therapeutic strategies, which may reduce the traditional mortality gap that still differentiates AMI patients with DM from those without.
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Chattopadhyay S, George A, John J, Sathyapalan T. Pre-diabetes mellitus newly diagnosed after myocardial infarction adversely affects prognosis in patients without known diabetes. Diab Vasc Dis Res 2019; 16:489-497. [PMID: 31044609 DOI: 10.1177/1479164119845561] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Effect of pre-diabetes mellitus on post-myocardial infarction prognosis is unclear. METHODS Retrospective cohort analysis of 1056 myocardial infarction survivors with fasting plasma glucose and 2-h post-load plasma glucose measured. Major adverse cardiovascular events included death, non-fatal reinfarction and ischaemic stroke. Cox proportional hazard regression identified predictors of event-free survival. Continuous net reclassification improvement and integrated discrimination improvement determined the added predictive value of glycaemic indices. RESULTS Major adverse cardiovascular events occurred in 25.1% and 16.4% patients with and without pre-diabetes mellitus (hazard ratio with pre-diabetes mellitus: 1.56; 95% confidence interval: 1.17-2.08; p = 0.003) in the whole cohort and in 24.1% and 17.2% patients (hazard ratio with pre-diabetes mellitus, 1.43; 95% confidence interval: 1.03-1.98; p = 0.033) in the matched cohort, respectively. Pre-diabetes mellitus predicted major adverse cardiovascular events-free survival in whole (hazard ratio: 1.39; 95% confidence interval: 1.03-1.89; p = 0.033) and matched cohorts (hazard ratio: 1.42; 95% confidence interval: 1.01-1.99; p = 0.043). The 2-h post-load plasma glucose, but not fasting plasma glucose, predicted major adverse cardiovascular events-free survival in the whole (hazard ratio: 1.16; 95% confidence interval: 1.07-1.26; p < 0.0001) and matched cohorts (hazard ratio: 1.20; 95% confidence interval: 1.09-1.31; p < 0.0001). Adding 2-h post-load plasma glucose to models containing fasting plasma glucose, significantly improved net reclassification improvement and integrated discrimination improvement for both cohorts, but not vice versa. CONCLUSION Pre-diabetes mellitus predicts major adverse cardiovascular events after myocardial infarction. The 2-h post-load plasma glucose predicts prognosis better than fasting plasma glucose in these patients.
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Affiliation(s)
| | - Anish George
- Department of Cardiology, Scunthorpe General Hospital, Scunthorpe, UK
| | - Joseph John
- Department of Cardiology, Castle Hill Hospital, Cottingham, UK
| | - Thozhukat Sathyapalan
- Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, University of Hull, Hull, UK
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McCarthy K, Conway R, Byrne D, Cournane S, O'Riordan D, Silke B. Hyponatraemia during an emergency medical admission as a marker of illness severity & case complexity. Eur J Intern Med 2019; 59:60-64. [PMID: 30097216 DOI: 10.1016/j.ejim.2018.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/23/2018] [Accepted: 08/01/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Altered sodium balance at time of an emergency medical admission adversely impacts on outcome; whether hyponatraemia is independently associated with outcomes or a surrogate of acute illness severity has been debated. METHODS All emergency medical admissions between 2002 and 2017 were studied and a risk score calculated. We compared univarate deciles of admission sodium using a multivariable model, adjusting for risk score. RESULTS There were 106,586 admissions in 54,928 patients. Patients with lower sodium at admission were older at 66.7 years (IQR 46.7-79.5) compared with 63.3 years (IQR 42.9-78.2) with a longer length of stay (LOS) of 6.8 days (IQR 3.0-14.7) versus 4.9 days (IQR 1.8-10.9). They had a higher 30-day in-hospital mortality at 6.4% vs 4.4% (p < 0.001). Admission sodium predicted survival - OR 0.89 (95%CI 0.88-0.90). We adjusted the model with a Risk Score that is predictive and exponentially related to 30-day in-hospital mortality. When adjusted for Risk Score, the admission sodium value was less predictive - OR 0.95 (95%CI 0.92-0.97). The cumulative percentages within the lowest five deciles fell from 63.3% between 2002 and 2009 to 48.1% from 2010 to 2017. The slope of the prediction line relating admission sodium to mortality did not change over time but a lower mortality rate was predicted at any given sodium level. CONCLUSION Hyponatraemia at the time of an emergency medical admission is predictive and probably a marker of Acuity Illness Severity and Case Complexity. Both the frequency of abnormality in admission sodium and mortality have fallen over time.
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Affiliation(s)
- Kevin McCarthy
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - Richard Conway
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - Declan Byrne
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - Seán Cournane
- Medical Physics and Bioengineering Department, St James's Hospital, Dublin 8, Ireland
| | - Deirdre O'Riordan
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - Bernard Silke
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland.
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Shah B, Newman JD, Woolf K, Ganguzza L, Guo Y, Allen N, Zhong J, Fisher EA, Slater J. Anti-Inflammatory Effects of a Vegan Diet Versus the American Heart Association-Recommended Diet in Coronary Artery Disease Trial. J Am Heart Assoc 2018; 7:e011367. [PMID: 30571591 PMCID: PMC6405545 DOI: 10.1161/jaha.118.011367] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 10/30/2018] [Indexed: 02/07/2023]
Abstract
Background Dietary interventions may play a role in secondary cardiovascular prevention. hsCRP (High-sensitivity C-reactive protein) is a marker of risk for major adverse cardiovascular outcomes in coronary artery disease. Methods and Results The open-label, blinded end-point, EVADE CAD (Effects of a Vegan Versus the American Heart Association-Recommended Diet in Coronary Artery Disease) trial randomized participants (n=100) with coronary artery disease to 8 weeks of a vegan or American Heart Association-recommended diet with provision of groceries, tools to measure dietary intake, and dietary counseling. The primary end point was high-sensitivity C-reactive protein. A linear regression model compared end points after 8 weeks of a vegan versus American Heart Association diet and adjusted for baseline concentration of the end point. Significance levels for the primary and secondary end points were set at 0.05 and 0.0015, respectively. A vegan diet resulted in a significant 32% lower high-sensitivity C-reactive protein (β, 0.68, 95% confidence interval [0.49-0.94]; P=0.02) when compared with the American Heart Association diet. Results were consistent after adjustment for age, race, baseline waist circumference, diabetes mellitus, and prior myocardial infarction (adjusted β, 0.67 [0.47-0.94], P=0.02). The degree of reduction in body mass index and waist circumference did not significantly differ between the 2 diet groups (adjusted β, 0.99 [0.97-1.00], P=0.10; and adjusted β, 1.00 [0.98-1.01], P=0.66, respectively). There were also no significant differences in markers of glycemic control between the 2 diet groups. There was a nonsignificant 13% reduction in low-density lipoprotein cholesterol with the vegan diet when compared with the American Heart Association diet (adjusted β, 0.87 [0.78-0.97], P=0.01). There were no significant differences in other lipid parameters. Conclusions In patients with coronary artery disease on guideline-directed medical therapy, a vegan diet may be considered to lower high-sensitivity C-reactive protein as a risk marker of adverse outcomes. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 02135939.
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Affiliation(s)
- Binita Shah
- Department of Medicine (Cardiology)New York University School of MedicineNew YorkNY
- VA New York Harbor Healthcare System (Manhattan Campus)New YorkNY
| | - Jonathan D. Newman
- Department of Medicine (Cardiology)New York University School of MedicineNew YorkNY
| | - Kathleen Woolf
- Department of Nutrition and Food StudiesNYU SteinhardtNew YorkNY
| | - Lisa Ganguzza
- Department of Medicine (Cardiology)New York University School of MedicineNew YorkNY
| | - Yu Guo
- Department of Population Health (Biostatistics)NYU School of MedicineNew YorkNY
| | - Nicole Allen
- Department of Medicine (Cardiology)New York University School of MedicineNew YorkNY
| | - Judy Zhong
- Department of Population Health (Biostatistics)NYU School of MedicineNew YorkNY
| | - Edward A. Fisher
- Department of Medicine (Cardiology)New York University School of MedicineNew YorkNY
| | - James Slater
- Department of Medicine (Cardiology)New York University School of MedicineNew YorkNY
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Papazafiropoulou AK, Patsourakos NG, Melidonis A. Prediabetes and Atherosclerotic Disease. Angiology 2018; 70:101-102. [DOI: 10.1177/0003319718812721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | | | - Andreas Melidonis
- 1st Department of Internal Medicine and Diabetes Center, Tzaneio General Hospital of Piraeus, Piraeus, Greece
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Chattopadhyay S, George A, John J, Sathyapalan T. Two-hour post-challenge glucose is a better predictor of adverse outcome after myocardial infarction than fasting or admission glucose in patients without diabetes. Acta Diabetol 2018; 55:449-458. [PMID: 29450734 DOI: 10.1007/s00592-018-1114-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 02/05/2018] [Indexed: 11/26/2022]
Abstract
AIMS We evaluate prevalence of new abnormal glucose tolerance (AGT) in post-MI survivors without known diabetes (DM) if guidelines are followed and compare the ability of admission (APG), fasting (FPG) and 2-h post-load plasma glucose (2h-PG) to predict prognosis. METHODS A total of 674 patients were followed up for 4 years for incidence of major adverse cardiovascular events (MACE) of cardiovascular death, non-fatal re-infarction or non-haemorrhagic stroke. Ability of models including APG, FPG and 2h-PG to predict MACE was compared. RESULTS Of the total, 93-96% of impaired glucose tolerance and 64-75% of DM would be missed with current guidelines. MACE was higher in the upper quartiles of 2h-PG. When 2h-PG and FPG were included simultaneously in models, only 2h-PG predicted MACE (HR 1.12, CI 1.04-1.20, p = 0.0012), all cause mortality (HR 1.17, CI 1.05-1.30, p = 0.0039), cardiovascular mortality (HR 1.17, CI 1.02-1.33, p = 0.0205) and non-fatal MI (HR 1.10, CI 1.01-1.20, p = 0.0291). Adding 2h-PG significantly improved ability of models including FPG (χ2 = 16.01, df = 1, p = 0.0001) or FPG and APG (χ2 = 17.36, df = 1, p = 0.000) to predict MACE. Model including 2h-PG only had the lowest Akaike's information criteria and highest Akaike weights suggesting that this was the best in predicting events. Adding 2h-PG to models including FPG or APG with other co-variates yielded continuous net reclassification improvement (NRI) of 0.22 (p = 0.026) and 0.27 (p = 0.005) and categorical NRI of 0.09 (p = 0.032) and 0.12 (p = 0.014), respectively. Adding 2 h-PG to models including only FPG, only APG and both yielded integrated discrimination improvement of 0.012 (p = 0.015), 0.022 (p = 0.001) and 0.013 (p = 0.014), respectively. CONCLUSIONS AGT is under-diagnosed on current guidelines. 2h-PG is a better predictor of prognosis compared to APG and FPG.
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Affiliation(s)
- Sudipta Chattopadhyay
- Department of Cardiology, Milton Keynes University Hospital, Standing Way, Milton Keynes, MK6 5LD, UK.
| | - Anish George
- Department of Cardiology, Scunthorpe General Hospital, Cliff Gardens, Scunthorpe, UK
| | - Joseph John
- Department of Cardiology, Castle Hill Hospital, Kingston upon Hull, UK
| | - Thozhukat Sathyapalan
- Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, University of Hull, Kingston upon Hull, UK
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Kosiborod M. Hyperglycemia in Acute Coronary Syndromes: From Mechanisms to Prognostic Implications. Endocrinol Metab Clin North Am 2018; 47:185-202. [PMID: 29407051 DOI: 10.1016/j.ecl.2017.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Numerous studies have documented that hyperglycemia is frequent in patients hospitalized with acute coronary syndromes, affects patients with and without established diabetes, and is associated with adverse outcomes, with incremental increase in risk of mortality and complications observed across the spectrum of glucose elevations. This article reviews present knowledge about the association between glucose levels and outcomes of patients hospitalized with acute coronary syndromes; describes available data regarding inpatient glucose management in this patient group, and comparative data across the spectrum of critically ill hospitalized patients; addresses some controversies in this field; and offers practical recommendations for patient management based on existing data.
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Affiliation(s)
- Mikhail Kosiborod
- Department of Cardiology, Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, USA; Department of Medicine, University of Missouri-Kansas City, 2411 Holmes, Kansas City, MO 64108, USA.
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Perez de la Hoz RA, Swieszkowski SP, Cintora FM, Aladio JM, Papini CM, Matsudo M, Scazziota AS. Neuroendocrine System Regulatory Mechanisms: Acute Coronary Syndrome and Stress Hyperglycaemia. Eur Cardiol 2018; 13:29-34. [PMID: 30310467 DOI: 10.15420/ecr.2017:19:3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Neurohormonal systems are activated in the early phase of acute coronary syndromes to preserve circulatory homeostasis, but prolonged action of these stress hormones might be deleterious. Cortisol reaches its peak at 8 hours after the onset of symptoms, and individuals who have continued elevated levels present a worse prognosis. Catecholamines reach 100-1,000-fold their normal plasma concentration within 30 minutes of ischaemia, therefore inducing the propagation of myocardial damage. Stress hyperglycaemia induces inflammation and endothelial dysfunction, and also has procoagulant and prothrombotic effects. Patients with hyperglycaemia and no diabetes elevated in-hospital and 12-month mortality rates. Hyperglycaemia in patients without diabetes has been shown to be an appropriate independent mortality prognostic factor in this type of patient.
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Affiliation(s)
| | | | | | | | | | - Maia Matsudo
- School of Medicine, Buenos Aires University Buenos Aires, Argentina
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Lee TF, Burt MG, Heilbronn LK, Mangoni AA, Wong VW, McLean M, Cheung NW. Relative hyperglycemia is associated with complications following an acute myocardial infarction: a post-hoc analysis of HI-5 data. Cardiovasc Diabetol 2017; 16:157. [PMID: 29233143 PMCID: PMC5725905 DOI: 10.1186/s12933-017-0642-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/06/2017] [Indexed: 01/08/2023] Open
Abstract
Background Hyperglycemia is associated with increased morbidity and mortality in patients with an acute myocardial infarction (AMI). We evaluated whether complications after AMI are associated with absolute or relative glycemia. Methods A total of 192 patients with AMI were randomized to intensive or conventional insulin therapy. Absolute glycemia was defined as mean blood glucose level (BGL) during the first 24 h following randomization. Relative glycemia was defined by the stress hyperglycaemia ratio (SHR), calculated as mean BGL divided by average glucose concentration over the prior 3 months estimated from glycosylated haemoglobin. The primary endpoint was a “complicated AMI”, defined as an AMI complicated by death, congestive cardiac failure, arrhythmia, cardiac arrest, reinfarction, cardiogenic shock, inotrope use or emergency revascularization. Results There was not a significant association between mean BGL and complicated AMI (odds ratio (OR) 1.05 per mmol/L glucose increment, 95% confidence intervals (CI) 0.93–1.19). In contrast, SHR was positively associated with a complicated myocardial infarction (OR 1.22 per 0.1 SHR increment, 95% CI 1.06–1.42), and individual complications of death (OR 1.55, 95% CI 1.14–2.11), congestive cardiac failure (OR 1.27, 95% CI 1.05–1.54), arrhythmia (OR 1.31, 95% CI 1.12–1.54) and cardiogenic shock (OR 1.42, 95% CI 1.03–1.97). The relationship between SHR and a complicated AMI was independent of diabetic status, intensive insulin therapy, sex and hypoglycemia. Conclusions Relative, but not absolute, glycemia during insulin treatment is independently associated with complications after an AMI. Future studies should investigate whether basing therapeutic glycaemic targets on relative glycemia improves patient outcomes.
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Affiliation(s)
- Tien F Lee
- School of Medicine, Flinders University, Adelaide, Australia. .,Southern Adelaide Diabetes & Endocrine Services, Repatriation General Hospital, Daw Park, Adelaide, SA, 5041, Australia.
| | - Morton G Burt
- School of Medicine, Flinders University, Adelaide, Australia.,Southern Adelaide Diabetes & Endocrine Services, Repatriation General Hospital, Daw Park, Adelaide, SA, 5041, Australia
| | | | | | - Vincent W Wong
- Centre for Diabetes & Endocrinology Research, Westmead Hospital, Sydney, Australia
| | - Mark McLean
- Centre for Diabetes & Endocrinology Research, Westmead Hospital, Sydney, Australia
| | - N Wah Cheung
- Centre for Diabetes & Endocrinology Research, Westmead Hospital, Sydney, Australia
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Egi M, Furushima N, Makino S, Mizobuchi S. Glycemic control in acute illness. Korean J Anesthesiol 2017; 70:591-595. [PMID: 29225740 PMCID: PMC5716815 DOI: 10.4097/kjae.2017.70.6.591] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 10/31/2017] [Accepted: 10/11/2017] [Indexed: 12/14/2022] Open
Abstract
Hyperglycemia is commonly observed in critical illness. A landmark large randomized controlled trial (RCT) reported that the incidence of hyperglycemia (blood glucose concentration > 108 mg/dl) was as high as 97.2% in critically ill patients. During the past two decades, a number of RCTs and several meta-analyses and network meta-analyses have been conducted to determine the optimal target for acute glycemic control. The results of those studies suggest that serum glucose concentration would be better to be maintained between 144 and 180 mg/dl. Although there have been studies showing an association of hypoglycemia with worsened clinical outcomes, a causal link has yet to be confirmed. Nonetheless, some researchers are of the view that the data suggest even mild hypoglycemia should be avoided in critically ill patients. Since acutely ill patients who receive insulin infusion are at a higher risk of hypoglycemia, a reliable devices for measuring blood glucose concentrations, such as an arterial blood gas analyzer, should be used frequently. Acute glycemic control in patients with premorbid hyperglycemia is a novel issue. Available literature suggests that blood glucose concentrations considered to be desirable and/or safe in non-diabetic critically ill patients might not be desirable in patients with diabetes. Moreover, the optimal target for acute blood glucose control may be higher in critically ill patients with premorbid hyperglycemia. Further study is required to assess optimal blood glucose control in acutely ill patients with premorbid hyperglycemia.
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Affiliation(s)
- Moritoki Egi
- Department of Anesthesiology, Kobe University Hospital, Kobe, Japan
| | - Nana Furushima
- Department of Anesthesiology, Kobe University Hospital, Kobe, Japan
| | - Shohei Makino
- Department of Anesthesiology, Kobe University Hospital, Kobe, Japan
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Soh S, Jun JH, Song JW, Shin EJ, Kwak YL, Shim JK. Ethyl pyruvate attenuates myocardial ischemia-reperfusion injury exacerbated by hyperglycemia via retained inhibitory effect on HMGB1. Int J Cardiol 2017; 252:156-162. [PMID: 29169909 DOI: 10.1016/j.ijcard.2017.11.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/19/2017] [Accepted: 11/13/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Hyperglycemia (HG) exacerbates myocardial ischemia/reperfusion (I/R) injury and renders protective strategies ineffective by amplified inflammatory response via enhanced high-mobility group box-1 (HMGB1) release. This study investigated the role of ethyl pyruvate (EP) against myocardial I/R injury under a clinically relevant HG condition. METHODS Sprague-Dawley rats (n=76) were randomly assigned to 6 groups: normoglycemia (NG)-Sham, NG-I/R-control (C, saline), NG-I/R-EP treatment (50mg/kg) upon reperfusion, HG-Sham, HG-I/R-C, and HG-I/R-EP treatment upon reperfusion. HG was induced by 1.2g/kg dextrose. I/R was induced by ligation of the left anterior descending artery for 30min followed by 4h of reperfusion. RESULTS HG resulted in exacerbation of myocardial infarct size by 19% with amplified activation of HMGB1-receptors of advanced glycation end products/toll like receptors-NF-κB pathway compared to NG following I/R, which all could be attenuated by EP. EP treatment was associated with diminished tumor necrosis factor-α, interleukin-1β, and interleukin-6 expressions. It also served to normalize the increase in pro-apoptotic Bax and the decrease in anti-apoptotic Bcl-2 protein levels. These effects were associated with decreased myocardial apoptosis and infarct size (by 30% and 36% in the NG and HG groups, respectively) regardless of the glycemic condition. CONCLUSION HG exacerbated myocardial I/R injury through amplified inflammatory response via increased HMGB1 level. EP treatment upon reperfusion conveyed significant myocardial protection against the I/R injury under both NG and HG conditions. Common to both glycemic conditions, associated mechanisms involved attenuated increase in HMGB1 level and suppression of its down-stream pathways.
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Affiliation(s)
- Sarah Soh
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea; Severance Cardiovascular Hospital, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Ji Hae Jun
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Jong Wook Song
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea; Severance Cardiovascular Hospital, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Eun-Jung Shin
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Young-Lan Kwak
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea; Severance Cardiovascular Hospital, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Jae-Kwang Shim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea; Severance Cardiovascular Hospital, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
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Predicting Outcomes in Emergency Medical Admissions Using a Laboratory Only Nomogram. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2017; 2017:5267864. [PMID: 29270210 PMCID: PMC5705890 DOI: 10.1155/2017/5267864] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 10/23/2017] [Indexed: 12/22/2022]
Abstract
Background We describe a nomogram to explain an Acute Illness Severity model, derived from emergency room triage and admission laboratory data, to predict 30-day in-hospital survival following an emergency medical admission. Methods For emergency medical admissions (96,305 episodes in 50,612 patients) between 2002 and 2016, the relationship between 30-day in-hospital mortality and admission laboratory data was determined using logistic regression. The previously validated Acute Illness Severity model was then transposed to a Kattan-style nomogram with a Stata user-written program. Results The Acute Illness Severity was based on the admission Manchester triage category and biochemical laboratory score; these latter were based on the serum albumin, sodium, potassium, urea, red cell distribution width, and troponin status. The laboratory admission data was predictive with an AUROC of 0.85 (95% CI: 0.85, 0.86). The sensitivity was 94.4%, with a specificity of 62.7%. The positive predictive value was 21.2%, with a negative predictive value of 99.1%. For the Kattan-style nomogram, the regression coefficients are converted to a 100-point scale with the predictor parameters mapped to a probability axis. The nomogram would be an easy-to-use tool at the bedside and for educational purposes, illustrating the relative importance of the contribution of each predictor to the overall score. Conclusion A nomogram to illustrate and explain the prognostic factors underlying an Acute Illness Severity Score system is described.
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Wang R, Mei B, Liao X, Lu X, Yan L, Lin M, Zhong Y, Chen Y, You T. Determination of risk factors affecting the in-hospital prognosis of patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention. BMC Cardiovasc Disord 2017; 17:243. [PMID: 28899364 PMCID: PMC5596504 DOI: 10.1186/s12872-017-0660-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/10/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To determine the factors affecting the in-hospital prognosis of patients with acute ST segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI), and to establish its prognostic discriminant model. METHODS A total of 701 consecutive STEMI patients undergoing PCI were enrolled in this study. The patients were divided into two groups, good prognosis and poor prognosis, based on whether the patient had adverse outcomes (death or heart function ≥ grade III) at discharge. Demographic and basic clinical characteristics, diagnosis at admission (e.g., ventricular function, complications, or hyperlipidemia), and biomedical indicators (e.g., blood count, basal metabolism and biochemical composition, blood lipid and glucose levels, myocardial biomarkers, and coagulation) were collected and analyzed. RESULTS We determined 22 factors as risk factors for the in-hospital prognosis of STEMI patients after PCI: age, cardiac function during hospitalization, complications, history of diabetes mellitus, et al., among which the history of diabetes, uric acid, urea nitrogen, and activated partial thromboplastin time (APTT) were independent risk factors. CONCLUSION We identified four independent risk factors for the in-hospital prognosis of STEMI patients after PCI and generated a prognostic model to predict the adverse outcomes of these patients.
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Affiliation(s)
- Rui Wang
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Biqi Mei
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Xinlong Liao
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Xia Lu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Lulu Yan
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Man Lin
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Yao Zhong
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Yili Chen
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080 China
| | - Tianhui You
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
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Irzmański R, Kapusta J, Obrębska-Stefaniak A, Urzędowicz B, Kowalski J. Cardiac rehabilitation in patients with ST-segment elevation myocardial infarction: can its failure be predicted? Ther Adv Cardiovasc Dis 2017; 11:177-184. [PMID: 28553755 DOI: 10.1177/1753944717706845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The prognosis in patients after acute coronary syndromes (ACS) is significantly burdened by coexisting anaemia, leukocytosis and low glomerular filtration rate (GFR). Hyperglycaemia in the early stages of ACS is a strong predictor of death and heart failure in non-diabetic subjects. This study aimed to evaluate the effect of hyperglycaemia, anaemia, leukocytosis, thrombocytopaenia and decreased GFR on the risk of the failure of cardiac rehabilitation (phase II at the hospital) in post-ST-segment elevation myocardial infarction (STEMI) patients. METHODS The study included 136 post-STEMI patients, 96 men and 40 women, aged 60.1 ± 11.8 years, admitted for cardiac rehabilitation (phase II) to the Department of Internal Medicine and Cardiac Rehabilitation, WAM University Hospital in Lodz, Poland. On admission fasting blood cell count was performed and serum glucose and creatinine level was determined (GFR assessment). The following results were considered abnormal: glucose ⩾ 100 mg/dl, GFR < 60 ml/min/1, 73 m², red blood cells (RBCs) < 4 × 106/μl, white blood cells (WBCs) > 10 × 103/μl; platelets (PLTs) < 150 × 10³/ml. In all patients an exercise test was performed twice, before and after the completion of the second stage of rehabilitation, to assess its effects. RESULTS Based on logistic regression analysis and the results of an individual odds ratio (OR) of the tested parameters, their prognostic impact was determined on the risk of failure of cardiac rehabilitation. This risk has been defined on the basis of the patient's inability to tolerate workload increment >5 Watt in spite of the applied program of cardiac rehabilitation. As a result of building a logistic regression model, the most statistically significant risk factors were selected, on the basis of which cardiac rehabilitation failure index was determined. leukocytosis and reduced GFR determined most significantly the risk of failure of cardiac rehabilitation (respectively OR = 6.42 and OR = 3.29, p = 0.007). These parameters were subsequently utilized to construct a rehabilitation failure index. CONCLUSIONS Peripheral blood cell count and GFR are important in assessing the prognosis of cardiac rehabilitation effects. leukocytosis and decreased GFR determine to the highest degree the risk of cardiac rehabilitation failure. Cardiac rehabilitation failure index may be useful in classifying patients into an appropriate model of rehabilitation. These findings support our earlier reports.
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Affiliation(s)
- Robert Irzmański
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, Poland
| | - Joanna Kapusta
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, Kościuszki 4, Lodz 90-419, Poland
| | | | - Beata Urzędowicz
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, Poland
| | - Jan Kowalski
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, Poland University of Social Science, Lodz, Poland
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Can we use plasma hyperosmolality as a predictor of mortality for ST-segment elevation myocardial infarction? Coron Artery Dis 2017; 28:70-76. [PMID: 27608320 DOI: 10.1097/mca.0000000000000426] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The aim of this study was to investigate the association of plasma osmolality with all-cause mortality in ST-segment elevation myocardial infarction (STEMI) patients treated with a primary percutaneous coronary intervention. METHODS This study included 3748 patients (mean age 58.3±11.8 years, men 81%) with STEMI treated with primary percutaneous coronary intervention. The following formula was used to measure the plasma osmolality at admission: osmolality=1.86×sodium (mmol/l)+glucose (mg/dl)/18+BUN (mg/dl)/2.8+9. RESULTS The patients were followed up for a mean period of 22±10 months. Patients with higher plasma osmolality had 3.7 times higher in-hospital (95% confidence interval: 2.7-5.1) and 3.2 times higher long-term (95% confidence interval: 2.5-4.1) all-cause mortality rates than patients with lower plasma osmolality. CONCLUSION Plasma osmolality was found to be a predictor of both in-hospital and long-term all-cause mortality. Hence, plasma osmolality can be used to detect high-risk patients in STEMI.
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Salviz EA, Onbasi S, Ozonur A, Orhan-Sungur M, Berkoz O, Tugrul KM. Comparison of Ultrasound-Guided Axillary Brachial Plexus Block Properties in Diabetic and Nondiabetic Patients: A Prospective Observational Study. J Hand Surg Am 2017; 42:190-197. [PMID: 28259276 DOI: 10.1016/j.jhsa.2017.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 12/31/2016] [Accepted: 01/11/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Patients with diabetes mellitus (DM) type 2 may have subclinical peripheral nerve neuropathy. We performed this study to compare the differences in duration of axillary brachial plexus blocks in patients with type 2 DM and without DM (NODM). Our hypothesis was that the sensory block duration would be prolonged in patients with DM. METHODS A total of 71 patients who were scheduled for elective forearm and/or hand surgery were enrolled in this study. Before surgery, they received ultrasound-guided axillary brachial plexus blocks with a mixture of 10 mL lidocaine 2% and 20 mL bupivacaine 0.5%. After surgery, all patients received 1 g paracetamol every 6 hours as needed. The primary end point was sensory block duration. Secondary end points were motor block duration, time until first pain (numeric rating scale [NRS] 4 or greater), highest NRS pain scores, and rescue analgesic consumption (NRS 4 or greater) through the first 2 postoperative days. RESULTS In all, 67 patients completed the study: 22 in the DM group and 45 in the NODM group. Sensory and motor block durations were longer in the DM group than in the NODM group (mean [range], 773.5 [479-1155] vs 375 [113-900] minutes, and 523 [205-955] vs 300 [110-680] minutes). Time until first pain was 855 (590-1,285) minutes in the DM group and 500 (200-990) minutes in the NODM group. The highest NRS scores were also significantly lower in the DM group at 6 and 12 hours. Paracetamol consumption was lower in the DM group through the first 2 postoperative days. CONCLUSIONS The presence of DM was associated with longer duration of the sensory block after axillary brachial plexus block. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Emine Aysu Salviz
- Department of Anesthesiology, Division of Hand, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Sukru Onbasi
- Department of Anesthesiology, Division of Hand, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Anil Ozonur
- Department of Anesthesiology, Division of Hand, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mukadder Orhan-Sungur
- Department of Anesthesiology, Division of Hand, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Omer Berkoz
- Department of Plastic and Reconstructive Surgery, Division of Hand, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kamil Mehmet Tugrul
- Department of Anesthesiology, Division of Hand, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Yang Y, Kim TH, Yoon KH, Chung WS, Ahn Y, Jeong MH, Seung KB, Lee SH, Chang K. The stress hyperglycemia ratio, an index of relative hyperglycemia, as a predictor of clinical outcomes after percutaneous coronary intervention. Int J Cardiol 2017; 241:57-63. [PMID: 28256326 DOI: 10.1016/j.ijcard.2017.02.065] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/19/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND We aimed to investigate the outcome-predicting value of a novel index of stress hyperglycemia in coronary artery disease (CAD) patients who underwent percutaneous coronary intervention (PCI). METHODS This was a retrospective observational study. Four-thousand-three-hundred-sixty-two subjects from the COACT registry were used to estimate the risk of major adverse cardiovascular and cerebrovascular events (MACCE), which are defined as composites of all-cause death, non-fatal myocardial infarction (MI) and non-fatal stroke. The stress hyperglycemia ratio (SHR) was calculated by dividing the random serum glucose at admission with the estimated average glucose derived from HbA1c. RESULTS Over a median follow-up of 2.5years, 344 (7.9%), 43 (1.0%), and 89 (2.0%) cases of death, non-fatal MI, and non-fatal stroke occurred, respectively. Compared with the subjects in the lower three quartiles of SHR, the HR (95% CI) for the highest SHR quartile (Q4) group for MACCE was 1.31 (1.05, 1.64) in the total population and 1.45 (1.02, 2.06) in the non-diabetic population after adjusting for potential covariables. The risk of MACCE in the SHR Q4 group was significantly higher in patients presenting with ST-elevation MI (STEMI), which was not the case for patients presenting with other CAD types. The prognostic impact of SHR was more prominent for the 30-day MACCE. Similar results were observed in another cohort consisting of patients who only presented with acute MI. CONCLUSIONS SHR is a useful predictive marker of MACCE after PCI, especially in non-diabetic patients with STEMI, which could be utilized to identify high-risk patients for adverse outcomes.
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Affiliation(s)
- Yeoree Yang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kun-Ho Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Wook Sung Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University, Gwangju, Republic of Korea
| | - Myung-Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University, Gwangju, Republic of Korea
| | - Ki-Bae Seung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Farhan S, Clare RM, Jarai R, Giugliano RP, Lokhnygina Y, Harrington RA, Kristin Newby L, Huber K. Fasting glucose, NT-proBNP, treatment with eptifibatide, and outcomes in non-ST-segment elevation acute coronary syndromes: An analysis from EARLY ACS. Int J Cardiol 2017; 232:264-270. [PMID: 28089149 DOI: 10.1016/j.ijcard.2017.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 12/29/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels have been linked to a more favorable glucometabolic profile. Little is known about the interaction of NT-proBNP and fasting glucose in non-ST-segment elevation acute coronary syndrome (NSTE ACS). METHODS Fasting glucose and NT-proBNP were measured in 2240 patients enrolled in the EARLY ACS trial. Multivariable Cox models were used to assess associations between fasting glucose and NT-proBNP and a 96-hour composite of death, myocardial infarction (MI), recurrent ischemia, or thrombotic bailout; 30-day death or MI; and 1-year mortality. RESULTS In adjusted Cox models, neither NT-proBNP nor fasting glucose was associated with the 96-hour endpoint (p=0.95 and p=0.87). NT-proBNP was associated with 30-day death or MI (hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.02-1.22, p=0.02) and 1-year mortality (HR 1.63, 95% CI 1.42-1.89, p<0.0001), but fasting glucose was associated only with 1-year death (HR 1.53, 95% CI 1.08-2.16, p=0.02). NT-proBNP×glucose interaction terms were non-significant in all models. As fasting glucose levels increased, the risk of 96-hour and 30-day endpoints increased among patients who received early eptifibatide but not delayed, provisional use (pint=0.035 and pint=0.029). Higher NT-proBNP levels were associated with greater 30-day death or MI among patients who received early eptifibatide but not delayed, provisional use (pint=0.045). CONCLUSION NT-proBNP and fasting glucose concentrations were associated with intermediate-term ischemic outcomes and may identify differential response to treatment with eptifibatide. CLINICALTRIALS. GOV IDENTIFIER NCT00089895.
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Affiliation(s)
- Serdar Farhan
- 3rd Department of Internal Medicine, Cardiology, and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria
| | | | - Rudolf Jarai
- 3rd Department of Internal Medicine, Cardiology, and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria
| | - Robert P Giugliano
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Robert A Harrington
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Kurt Huber
- 3rd Department of Internal Medicine, Cardiology, and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria.
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Boas Soja AM, Zwisler ADO, Melchior T, Hommel E, Torp-Pedersen C, Madsen M. Prevalence and characteristics of impaired glucose metabolism in patients referred to comprehensive cardiac rehabilitation: the DANSUK study. ACTA ACUST UNITED AC 2016; 13:784-90. [PMID: 17001219 DOI: 10.1097/01.hjr.0000238391.12223.d0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lifestyle and pharmacological interventions can delay the progression of impaired glucose tolerance (IGT) to type 2 diabetes (T2DM), and there is growing evidence that earlier detection of T2DM and intensified risk factor management may result in improved cardiovascular morbidity and mortality. We studied the prevalence of impaired glucose metabolism (T2DM, IGT and impaired fasting glucose; IFG) in patients referred to cardiac rehabilitation, and further studied whether we could identify groups in which an oral glucose tolerance test (OGTT) need not be performed. METHODS As part of a cardiac rehabilitation trial, 201 patients participated. Patients without a diagnosis of T2DM (N=159) underwent an OGTT 3 months after inclusion. RESULTS Forty-two patients (21%) had known T2DM at enrolment. Based on the OGTT, 26 patients (13%) had unrecognized T2DM, 36 (18%) had IGT and 19 (9%) were diagnosed with isolated IFG according to the World Health Organization definition. Using fasting plasma glucose alone, 19% of the patients with unrecognized T2DM and two-thirds of patients with IGT would be misclassified. Using IFG as a means to detect IGT showed a sensitivity of only 33% and a positive predictive value of 39%. CONCLUSION More than 60% of the patients (123/201) referred to cardiac rehabilitation had impaired glucose metabolism and 18% of the screened patients (29/159) would be misclassified if an OGTT was omitted. IFG and IGT did not identify the same patients or the same cardiovascular risk profile. An OGTT test should therefore be considered a constituent part of routine care management in cardiac rehabilitation settings.
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Affiliation(s)
- Anne Merete Boas Soja
- Bispebjerg University Hospital, Department of Cardiology, Copenhagen bNational Institute of Public Health, Copenhagen, Denmark.
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Liang H, Guo YC, Chen LM, Li M, Han WZ, Zhang X, Jiang SL. Relationship between fasting glucose levels and in-hospital mortality in Chinese patients with acute myocardial infarction and diabetes mellitus: a retrospective cohort study. BMC Cardiovasc Disord 2016; 16:156. [PMID: 27484985 PMCID: PMC4969715 DOI: 10.1186/s12872-016-0331-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 07/01/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated that elevated admission and fasting glucose (FG) is associated with worse outcomes in patients with acute myocardial infarction (AMI). However, the quantitative relationship between FG levels and in-hospital mortality in patients with AMI remains unknown. The aim of the study is to assess the prevalence of elevated FG levels in hospitalized Chinese patients with AMI and diabetes mellitus and to determine the quantitative relationship between FG levels and the in-hospital mortality as well as the optimal level of FG in patients with AMI and diabetes mellitus. METHODS A retrospective study was carried out in 1856 consecutive patients admitted for AMI and diabetes mellitus from 2002 to 2013. Clinical variables of baseline characteristics, in-hospital management and in-hospital adverse outcomes were recorded and compared among patients with different FG levels. RESULTS Among all patients recruited, 993 patients (53.5 %) were found to have FG ≥100 mg/dL who exhibited a higher in-hospital mortality than those with FG < 100 mg/dL (P < 0.001). Although there was a high correlation between FG levels and in-hospital mortality in all patients (r = 0.830, P < 0.001), the relationship showed a J-curve configuration with an elevated mortality when FG was less than 80 mg/dL. Using multivariate logistic regression models, we identified that age, FG levels and Killip class of cardiac function were independent predictors of in-hospital mortality in AMI patients with diabetes mellitus. CONCLUSIONS More than half of patients with AMI and diabetes mellitus have FG ≥100 mg/dL and the relationship between in-hospital mortality and FG level was a J-curve configuration. Both FG ≥ 100 mg/dL and FG <80 mg/dL were identified to be independent predictors of in-hospital mortality and thus the optimal FG level in AMI patients with diabetes mellitus appears to be 80-100 mg/dL.
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Affiliation(s)
- Hao Liang
- The Ultrasonic Diagnosis and Treatment Department, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Yi Chen Guo
- Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong University, No.324, Jing Wu Wei Qi Road, Jinan, 250021, Shandong, People's Republic of China
| | - Li Ming Chen
- Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong University, No.324, Jing Wu Wei Qi Road, Jinan, 250021, Shandong, People's Republic of China
| | - Min Li
- Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong University, No.324, Jing Wu Wei Qi Road, Jinan, 250021, Shandong, People's Republic of China
| | - Wei Zhong Han
- Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong University, No.324, Jing Wu Wei Qi Road, Jinan, 250021, Shandong, People's Republic of China
| | - Xu Zhang
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Shi Liang Jiang
- Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong University, No.324, Jing Wu Wei Qi Road, Jinan, 250021, Shandong, People's Republic of China.
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Relationship of non-cardiac biomarkers with periprocedural myocardial injury in patients undergoing percutaneous coronary intervention. Int J Cardiol 2016; 221:726-33. [PMID: 27428312 DOI: 10.1016/j.ijcard.2016.07.131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 07/08/2016] [Indexed: 01/05/2023]
Abstract
percutaneous coronary intervention (PCI) is one of the dominant methods for revascularization in patient with coronary artery disease (CAD), which accompanied with high incidence of periprocedural myocardial injury (PMI) evaluated by postprocedural cardiac biomarker elevation. For the convenience of risk stratification of PMI following PCI, the aim of present review provides a unique opportunity to summarize the relationship of non-cardiac biomarkers with PMI by extensively searching in the MEDLINE to identify all the relevant studies. In conclusion, we found that PCI related PMI might be correlated positively to those non-cardiac biomarkers such as low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol, total cholesterol, triglyceride, the ratios of LDL-C to high-density lipoprotein cholesterol (HDL-C), the ratios of HDL-C to apolipoprotein A-I, the ratio of eicosapentaenoic acid to arachidonic acid, lectin-like oxidized low-density lipoprotein receptor-1, C-reactive protein, high on-treatment platelet reactivity, platelet-monocyte aggregates, N-term pro-B-type natriuretic peptide, hemoglobin and albuminuria. Inversely, no relationships of PMI with those non-cardiac biomarkers such as mean platelet volume, platelet distribution width, platelet-larger cell ratio, uric acid, eosinophils count and the genetic variant of methylenetetrahydrofolate reductase (MTHFR) 677 C>T polymorphism. Moreover, there were controversial associations between PMI and those non-cardiac biomarkers such as high-density lipoprotein cholesterol, glycosylated hemoglobin, homocysteine and the polymorphism Leu33Pro of platelet glycoprotein IIbIIIa. However, almost all studies failed to provide definite mechanism of its findings, and further reaches are needed to focus on the potential mechanisms of association between non-cardiac biomarkers and PMI related to PCI.
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Pereira VR, Azuma RA, Gatto BEO, Silva Junior JM, Carmona MJC, Malbouisson LMS. [Hyperglycemia assessment in the post-anesthesia care unit]. Rev Bras Anestesiol 2016; 67:565-570. [PMID: 27005828 DOI: 10.1016/j.bjan.2015.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 08/17/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Hyperglycemia in surgical patients may cause serious problems. Analyzing this complication in this scenario contributes to improve the management of these patients. The aim of this study was to evaluate the prevalence of hyperglycemia in the post-anesthetic care unit (PACU) in non-diabetic patients undergoing elective surgery and analyze the possible risk factors associated with this complication. METHODS We evaluated non-diabetic patients undergoing elective surgeries and admitted in the PACU. Data were collected from medical records through precoded questionnaire. Hyperglycemia was considered when blood glucose was>120mg.dL-1. Patients with hyperglycemia were compared to normoglycemic ones to assess factors associated with the problem. We excluded patients with endocrine-metabolic disorders, diabetes, children under 18 years, body mass index (BMI) below 18 or above 35, pregnancy, postpartum or breastfeeding, history of drug use, and emergency surgeries. RESULTS We evaluated 837 patients. The mean age was 47.8±16.1 years. The prevalence of hyperglycemia in the postoperative period was 26.4%. In multivariate analysis, age (OR=1.031, 95% CI 1.017-1.045); BMI (OR=1.052, 95% CI 1.005-1.101); duration of surgery (OR=1.011, 95% CI 1.008-1.014), history of hypertension (OR=1.620, 95% CI 1.053-2.493), and intraoperative use of corticosteroids (OR=5.465, 95% CI 3.421-8.731) were independent risk factors for postoperative hyperglycemia. CONCLUSION The prevalence of hyperglycemia was high in the PACU, and factors such as age, BMI, corticosteroids, blood pressure, and duration of surgery are strongly related to this complication.
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Affiliation(s)
- Vinicius Rodovalho Pereira
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas de São Paulo, São Paulo, SP, Brasil
| | - Rodrigo Akio Azuma
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas de São Paulo, São Paulo, SP, Brasil
| | - Bruno Emanuel Oliva Gatto
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas de São Paulo, São Paulo, SP, Brasil
| | - João Manoel Silva Junior
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas de São Paulo, São Paulo, SP, Brasil.
| | - Maria Jose Carvalho Carmona
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas de São Paulo, São Paulo, SP, Brasil
| | - Luiz Marcelo Sá Malbouisson
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas de São Paulo, São Paulo, SP, Brasil
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Chen X, Li M, Jiang H, Li Y, Mo J, Lin P, Graham CA, Rainer TH. STEMI Outcomes in Guangzhou and Hong Kong: Two-Centre Retrospective Interregional Study. PLoS One 2016; 11:e0149981. [PMID: 26959984 PMCID: PMC4784728 DOI: 10.1371/journal.pone.0149981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 01/29/2016] [Indexed: 11/28/2022] Open
Abstract
Background and Objectives Healthcare systems are organized very differently in Hong Kong (HK) and Guangzhou (GZ). This study compared managements of the emergency departments (ED) and one-year mortalities of ST-segment elevation myocardial infarction (STEMI) patients in two teaching hospitals in Guangzhou and Hong Kong. Methods Retrospective observational study of STEMI mortalities and treatments in the Prince of Wales Hospital (PWH) and the Second Affiliated Hospital of Guangzhou Medical University (AHGZMU), was conducted between January and December 2010. The primary outcome was one-year all cause mortality. Results Univariate analysis of 76 cases from PWH and 111 cases from AHGZMU showed similar clinical characteristics, except for lower proportions of males (74% vs 92%, P = 0.002), hyperlipidemia (5% vs 25%, P<0.001), and Killip class I (56% vs 91%; P<0.001) in AHGZMU. The onset-to-door time of STEMI patients in AHGZMU was longer than in PWH (median 205 min [(IQR: 95–432) vs 120 min (IQR: 55–225), P = 0.001]. In AHGZMU, 85 (77%) patients received primary percutaneous coronary intervention (PPCI) as the main reperfusion treatment, whereas 18 (24%) received PPCI and 51 (67%) patients received thrombolytic therapy in PWH. Overall the one-year mortality in AHGZMU was 20%, whilst in PWH it was 14% (P = 0.436). The standardized one-year all-cause mortality ratios for AHGZMU and PWH were comparable (18.7 vs. 18.2%, P = 0894). Independent predictors of one-year mortality included older age (>67 years) and hyperglycemia (>10 mmol/L). Aged over 65 years, presence of anterior wall infarct, body weight ≤65 kg, SBP <100 mmHg at ED and glucose level >10 mmol/L were the independent predictors of in-hospital MACE. Conclusion There was no statistically significant difference between the standardized one-year all-cause mortalities of STEMI patients in the setting mainly using thrombolysis with shorter door-to-treatment time and the setting mainly using PCI with longer door-to-treatment time. Aged over 67 years and glucose level over 10 mmol/L were the independent predictors of one-year mortality. Older age, presence of anterior wall infarct, lower body weight, lower SBP at ED and hyperglycemia were the independent predictors of in-hospital MACE.
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Affiliation(s)
- Xiaohui Chen
- Emergency Department, The 2nd Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Min Li
- Emergency Department, The 2nd Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huilin Jiang
- Emergency Department, The 2nd Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong, China
| | - Yunmei Li
- Emergency Department, The 2nd Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong, China
| | - Junrong Mo
- Emergency Department, The 2nd Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong, China
| | - Peiyi Lin
- Emergency Department, The 2nd Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Colin A. Graham
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong, China
| | - Timothy H. Rainer
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong, China
- * E-mail:
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George A, Bhatia RT, Buchanan GL, Whiteside A, Moisey RS, Beer SF, Chattopadhyay S, Sathyapalan T, John J. Impaired Glucose Tolerance or Newly Diagnosed Diabetes Mellitus Diagnosed during Admission Adversely Affects Prognosis after Myocardial Infarction: An Observational Study. PLoS One 2015; 10:e0142045. [PMID: 26571120 PMCID: PMC4646628 DOI: 10.1371/journal.pone.0142045] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/17/2015] [Indexed: 02/07/2023] Open
Abstract
Objective To investigate the prognostic effect of newly diagnosed diabetes mellitus (NDM) and impaired glucose tolerance (IGT) post myocardial infarction (MI). Research Design and Methods Retrospective cohort study of 768 patients without preexisting diabetes mellitus post-MI at one centre in Yorkshire between November 2005 and October 2008. Patients were categorised as normal glucose tolerance (NGT n = 337), IGT (n = 279) and NDM (n = 152) on pre- discharge oral glucose tolerance test (OGTT). Primary end-point was the first occurrence of major adverse cardiovascular events (MACE) including cardiovascular death, non-fatal MI, severe heart failure (HF) or non-haemorrhagic stroke. Secondary end-points were all cause mortality and individual components of MACE. Results Prevalence of NGT, impaired fasting glucose (IFG), IGT and NDM changed from 90%, 6%, 0% and 4% on fasting plasma glucose (FPG) to 43%, 1%, 36% and 20% respectively after OGTT. 102 deaths from all causes (79 as first events of which 46 were cardiovascular), 95 non fatal MI, 18 HF and 9 non haemorrhagic strokes occurred during 47.2 ± 9.4 months follow up. Event free survival was lower in IGT and NDM groups. IGT (HR 1.54, 95% CI: 1.06–2.24, p = 0.024) and NDM (HR 2.15, 95% CI: 1.42–3.24, p = 0.003) independently predicted MACE free survival. IGT and NDM also independently predicted incidence of MACE. NDM but not IGT increased the risk of secondary end-points. Conclusion Presence of IGT and NDM in patients presenting post-MI, identified using OGTT, is associated with increased incidence of MACE and is associated with adverse outcomes despite adequate secondary prevention.
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Affiliation(s)
- Anish George
- Department of Cardiology, Scunthorpe General Hospital, Scunthorpe, United Kingdom
| | - Raghav T. Bhatia
- Department of Cardiology, Castle Hill Hospital, Kingston upon Hull, United Kingdom
| | - Gill L. Buchanan
- Department of Cardiology, Scunthorpe General Hospital, Scunthorpe, United Kingdom
| | - Anne Whiteside
- Department of Diabetes and Endocrinology, Scunthorpe General Hospital, Scunthorpe, United Kingdom
| | - Robert S. Moisey
- Department of Diabetes and Endocrinology, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, United Kingdom
| | - Stephen F. Beer
- Department of Diabetes and Endocrinology, Scunthorpe General Hospital, Scunthorpe, United Kingdom
| | | | - Thozhukat Sathyapalan
- Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom
| | - Joseph John
- Department of Cardiology, Castle Hill Hospital, Kingston upon Hull, United Kingdom
- * E-mail:
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Gohbara M, Hibi K, Mitsuhashi T, Maejima N, Iwahashi N, Kataoka S, Akiyama E, Tsukahara K, Kosuge M, Ebina T, Umemura S, Kimura K. Glycemic Variability on Continuous Glucose Monitoring System Correlates With Non-Culprit Vessel Coronary Plaque Vulnerability in Patients With First-Episode Acute Coronary Syndrome - Optical Coherence Tomography Study. Circ J 2015; 80:202-10. [PMID: 26511357 DOI: 10.1253/circj.cj-15-0790] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Glycemic variability (GV) is associated with coronary plaque rupture at the culprit lesion in acute myocardial infarction (AMI). The present study determined the relationship between GV and coronary plaque vulnerability in the non-culprit vessel. METHODS AND RESULTS The present prospective study involved 46 patients with first-episode acute coronary syndrome (ACS) who underwent optical coherence tomography in the non-culprit vessel. The relationship between GV, assessed with continuous glucose monitoring system, and the presence of thin-cap fibroatheroma (TCFA) at the non-culprit plaque with mild-to-moderate stenosis in the non-culprit vessel, was assessed. GV was quantified using mean amplitude of glycemic excursion (MAGE). Patients were divided into tertiles according to MAGE. TCFA was observed in 13 (28%) of the 46 patients. Fibrous cap thickness was thinner (MAGE tertiles: high, 80±40 µm; intermediate, 152±122 µm; low, 155±102 µm; P=0.01), and TCFA was more common (MAGE tertiles: high, 50%; intermediate, 27%; low, 7%; P=0.03) in patients with high MAGE. On multivariate logistic analysis high MAGE was the only significant determinant of TCFA, independent of coronary risk factors (OR, 5.000; P=0.021), homeostasis model assessment of insulin resistance, and hemoglobin A1c(OR, 5.674; P=0.018). CONCLUSIONS High MAGE measured early after the onset of first-episode ACS correlated with thinner fibrous cap thickness and higher prevalence of TCFA at the non-culprit plaque in the non-culprit vessel.
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Affiliation(s)
- Masaomi Gohbara
- Division of Cardiology, Yokohama City University Medical Center
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Benamer S, Eljazwi I, Mohamed R, Masoud H, Tuwati M, Elbarsha AM. Association of Hyperglycemia with In-Hospital Mortality and Morbidity in Libyan Patients with Diabetes and Acute Coronary Syndromes. Oman Med J 2015; 30:326-30. [PMID: 26421112 DOI: 10.5001/omj.2015.67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Hyperglycemia on admission and during hospital stay is a well-established predictor of short-term and long-term mortality in patients with acute myocardial infarction. Our study investigated the impact of blood glucose levels on admission and in-hospital hyperglycemia on the morbidity and mortality of Libyan patients admitted with acute coronary syndromes (acute myocardial infarction and unstable angina). METHODS In this retrospective study, the records of patients admitted with acute coronary syndrome to The 7th Of October Hospital, Benghazi, Libya, between January 2011 and December 2011 were reviewed. The level of blood glucose on admission, and the average blood glucose during the hospital stay were recorded to determine their effects on in-hospital complications (e.g. cardiogenic shock, acute heart failure, arrhythmias, and/or heart block) and mortality. RESULTS During the study period, 121 patients with diabetes were admitted with acute coronary syndrome. The mortality rate in patients with diabetes and acute coronary syndrome was 12.4%. Patients with a mean glucose level greater than 200mg/dL had a higher in-hospital mortality and a higher rate of complications than those with a mean glucose level ≤200mg/dL (27.5% vs. 2.6%, p<0.001 and 19.7% vs. 45.5%, p=0.004, respectively). There was no difference in in-hospital mortality between patients with a glucose level at admission ≤140mg/dL and those admitted with a glucose level >140mg/dL (6.9% vs. 14.3%; p=0.295), but the rate of complications was higher in the latter group (13.8% vs. 34.1%; p=0.036). Patients with admission glucose levels >140mg/dL also had a higher rate of complications at presentation (26.4% vs. 6.9%; p=0.027). CONCLUSION In patients with diabetes and acute coronary syndrome, hyperglycemia during hospitalization predicted a worse outcome in terms of the rates of in-hospital complications and in-hospital mortality. Hyperglycemia at the time of admission was also associated with higher rate of complications particularly at the time of presentation.
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Affiliation(s)
- Sufyan Benamer
- Department of Medicine, University of Benghazi, Benghazi, Libya
| | - Imhemed Eljazwi
- Department of Medicine, University of Benghazi, Benghazi, Libya
| | - Rima Mohamed
- Department of Medicine, The 7th Of October Hospital, Benghazi, Libya
| | - Heba Masoud
- Department of Medicine, The 7th Of October Hospital, Benghazi, Libya
| | - Mussa Tuwati
- Department of Medicine, University of Benghazi, Benghazi, Libya
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Conway R, Byrne D, O'Riordan D, Silke B. Patient risk profiling in acute medicine: the way forward? QJM 2015; 108:689-96. [PMID: 25614618 DOI: 10.1093/qjmed/hcv014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The identification of high-risk patients could form a basis for targetted intervention following an emergency medical admission. METHODS All emergency admissions to our institution over 12 years (2002-13) were included. An Illness Severity method based on admission laboratory parameters, previously developed between 2002 and 2007, was investigated for the 2008-13 cohort. We compared the area under the receiver operating characteristic (AUROC) to predict a 30-day in-hospital death between the original and validating cohorts using logistic multiple variable analyses. We defined six risk subgroups, based on admission laboratory data and examined the frequency of 30-day in-hospital mortality within these subgroups. RESULTS About 66 933 admissions were recorded in 36 271 patients. Between 2002 and 2007, the 30-day in-hospital mortality was 11.3% but between 2008 and 2013 was 6.7% (P < 0.001). This represented an absolute risk reduction (ARR) of 4.6%, a relative risk reduction (RRR) of 41.0%, and a number needed to treat of 21.6. The laboratory model was similarly predictive in both cohorts-for 2002-07, the AUROC was 0.82 (95% CI 0.81, 0.82) and for 2008-13 was 0.82 (95% CI 0.81, 0.83). Two high-risk subgroups were identified within each cohort; for 2002-07, these contained 15.0 and 30.2% of admitted patients but 95.5% of in-hospital deaths. For 2008-13, these two groups contained 15.7 and 31.0% of admitted patients but 97.0% of in-hospital deaths. CONCLUSION A previously described laboratory score method, based on admission biochemistry, identified patients at high risk for an in-hospital death. Risk profiling at admission is feasible for emergency medical admissions and could offer a means to outcome improvement.
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Affiliation(s)
- R Conway
- From the Department of Internal Medicine, St. James's Hospital, James Street, Dublin 8, Ireland
| | - D Byrne
- From the Department of Internal Medicine, St. James's Hospital, James Street, Dublin 8, Ireland
| | - D O'Riordan
- From the Department of Internal Medicine, St. James's Hospital, James Street, Dublin 8, Ireland
| | - B Silke
- From the Department of Internal Medicine, St. James's Hospital, James Street, Dublin 8, Ireland
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Zhang X, Dong L, Wang Q, Xie X. The relationship between fasting plasma glucose and MPO in patients with acute coronary syndrome. BMC Cardiovasc Disord 2015; 15:93. [PMID: 26307104 PMCID: PMC4548711 DOI: 10.1186/s12872-015-0088-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 08/13/2015] [Indexed: 01/04/2023] Open
Abstract
Background Inflammation plays a critical role in the progression of atherosclerosis, and hyperglycemia is a common feature in patients with ACS. We investigated the relationship between fasting plasma glucose (FPG) levels and the levels of the inflammatory factor, myeloperoxidase (MPO), in patients with acute coronary syndrome (ACS). Method A total of 85 patients with no prior history of diabetes mellitus were recruited. The patients were divided into three groups based on their FPG levels as follows: group A, FPG < 5.6 mmol/l; group B, 5.6 mmol/l ≤ FPG < 6.1 mmol/l; and group C, FPG ≥ 6.1 mmol/l. The FPG concentrations and plasma MPO levels were determined, coronary angioplasty was performed, and the Gensini scores were used to evaluate the severity of the coronary lesion. The MPO expression in peripheral blood mononuclear cells (PBMCs) in patients with ACS was determined using western blot analysis. Result The results demonstrated that the levels of FPG were significantly and positively correlated with plasma MPO levels, Gensini scores, high sensitive C reaction protein(hs-CRP)levels, leukocyte and neutrophils count. In multivariate regression analyses the FPG levels were positively correlated with plasma MPO levels, Gensini score and hs-CRP. The plasma MPO levels in the group C [68.68(52.62–91.88) U/L] were significantly higher than in the group A [63.04(26.18–97.75) U/L] and group B [58.22(23.95–89.54) U/L]. The plasma hs-CRP concentrations are also higher in group C [42.28 (0.31–169.40) mg/L] than in the group A [12.51(0.28–176.25) mg/L] and group B [14.7 (0.14–89.68) mg/L]. Conclusion This study demonstrates that FPG values are positively correlated with plasma MPO levels, suggesting MPO may play a role in the proatherogenesis of high FPG.
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Affiliation(s)
- Xiangyu Zhang
- Department of Geriatrics, Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, P. R. China.
| | - Lini Dong
- Department of Geriatrics, Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, P. R. China.
| | - Qiong Wang
- Department of Geriatrics, Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, P. R. China.
| | - Xiaomei Xie
- Department of Geriatrics, Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, P. R. China.
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Massalha S, Luria L, Kerner A, Roguin A, Abergel E, Hammerman H, Boulos M, Dragu R, Kapeliovich MR, Beyar R, Nikolsky E, Aronson D. Heart failure in patients with diabetes undergoing primary percutaneous coronary intervention. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:455-462. [PMID: 26228449 DOI: 10.1177/2048872615598632] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/12/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Diabetes mellitus is associated with increased risk after acute coronary syndromes. Primary percutaneous coronary intervention is the most effective method of reperfusion for acute ST-elevation myocardial infarction and can limit the ischaemic damage to the left ventricle. However, there are few data on the impact of diabetes mellitus on the risk of heart failure following primary percutaneous coronary intervention. METHODS We studied 958 ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention, of whom 263 (27.5%) had diabetes mellitus, with 67 (7.0%) treated with insulin. The primary end points of the study were re-admission for heart failure. Secondary end points were all-cause mortality and recurrent infarctions. The follow-up period was 5 years after hospital discharge. RESULTS The cumulative incidence of re-admission for heart failure was 8.4%, 15.2% and 26.7% in patients without diabetes mellitus, non-insulin-treated and insulin-treated diabetes mellitus, respectively. Compared with patients without diabetes mellitus, the adjusted hazard ratio for heart failure was 1.95 (95% confidence intervals 1.30-2.93) and 3.09 (95% confidence intervals 1.71-5.60) in non-insulin-treated and insulin-treated diabetes mellitus, respectively. The corresponding hazard ratios for mortality were 1.03 (95% confidence intervals 0.68-1.55) and 2.04 (95% confidence intervals 1.22-3.42), respectively. There was a J-shaped association between fasting glucose levels in the acute phase and risk of mortality (P=0.0001) and a direct association with heart failure (P=0.03). CONCLUSION Despite modern treatment of ST-elevation myocardial infarction and high levels of guideline-based medical care, diabetes mellitus had an independent adverse effect on the risk of re-admissions for heart failure, which was particularly high among insulin-treated patients.
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Affiliation(s)
| | - Lior Luria
- Departments of Cardiology, Rambam Medical Center
| | - Arthur Kerner
- Departments of Cardiology, Rambam Medical Center B. Rappaport Faculty of Medicine, Technion Medical School, Israel
| | - Ariel Roguin
- Departments of Cardiology, Rambam Medical Center B. Rappaport Faculty of Medicine, Technion Medical School, Israel
| | | | - Haim Hammerman
- Departments of Cardiology, Rambam Medical Center B. Rappaport Faculty of Medicine, Technion Medical School, Israel
| | - Monther Boulos
- Departments of Cardiology, Rambam Medical Center B. Rappaport Faculty of Medicine, Technion Medical School, Israel
| | - Robert Dragu
- Departments of Cardiology, Rambam Medical Center
| | - Michael R Kapeliovich
- Departments of Cardiology, Rambam Medical Center B. Rappaport Faculty of Medicine, Technion Medical School, Israel
| | - Rafael Beyar
- Departments of Cardiology, Rambam Medical Center B. Rappaport Faculty of Medicine, Technion Medical School, Israel
| | - Eugenia Nikolsky
- Departments of Cardiology, Rambam Medical Center B. Rappaport Faculty of Medicine, Technion Medical School, Israel
| | - Doron Aronson
- Departments of Cardiology, Rambam Medical Center B. Rappaport Faculty of Medicine, Technion Medical School, Israel
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44
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Angeli F, Reboldi G, Poltronieri C, Lazzari L, Sordi M, Garofoli M, Bartolini C, Verdecchia P. Hyperglycemia in acute coronary syndromes: from mechanisms to prognostic implications. Ther Adv Cardiovasc Dis 2015; 9:412-24. [PMID: 26194489 DOI: 10.1177/1753944715594528] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Hyperglycemia is a frequent condition in patients with acute coronary syndromes (ACS). Hyperglycemia during ACS is caused by an inflammatory and adrenergic response to ischemic stress, when catecholamines are released and glycogenolysis induced. Although the involved pathophysiological mechanisms have not yet been fully elucidated, it is believed that hyperglycemia is associated with an increase in free fat acids (which induce cardiac arrhythmias), insulin resistance, chemical inactivation of nitric oxide and the production of oxygen reactive species (with consequent microvascular and endothelial dysfunction), a prothrombotic state, and vascular inflammation. It is also related to myocardial metabolic disorders, leading to thrombosis, extension of the damaged area, reduced collateral circulation, and ischemic preconditioning. In the last few years, several observational studies demonstrated that hyperglycemia in ACS is a powerful predictor of survival, increasing the risk of immediate and long-term complications in patients both with and without previously known diabetes mellitus. Glucose management strategies in ACS may improve outcomes in patients with hyperglycemia, perhaps by reducing inflammatory and clotting mediators, by improving endothelial function and fibrinolysis and by reducing infarct size. Recent clinical trials of insulin in ACS have resulted in varying levels of benefit, but the clinical benefit of an aggressive treatment with insulin is yet unproved.
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Affiliation(s)
- Fabio Angeli
- Division of Cardiology and Cardiovascular Pathophysiology, Hospital S.M. della Misericordia, Perugia, Italy
| | - Gianpaolo Reboldi
- Department of Internal Medicine, University of Perugia, Perugia, Italy
| | | | - Ludovico Lazzari
- Department of Cardiology, University Hospital of Terni, Terni, Italy
| | - Martina Sordi
- Department of Cardiology, University Hospital of Terni, Terni, Italy
| | - Marta Garofoli
- Department of Internal Medicine, Hospital of Assisi, Assisi, Italy
| | | | - Paolo Verdecchia
- Department of Internal Medicine, Hospital of Assisi, Assisi, Italy
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45
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Gohbara M, Iwahashi N, Kataoka S, Hayakawa Y, Sakamaki K, Akiyama E, Maejima N, Tsukahara K, Hibi K, Kosuge M, Ebina T, Umemura S, Kimura K. Glycemic Variability Determined by Continuous Glucose Monitoring System Predicts Left Ventricular Remodeling in Patients With a First ST-Segment Elevation Myocardial Infarction. Circ J 2015; 79:1092-9. [PMID: 25739857 DOI: 10.1253/circj.cj-14-1226] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Impaired glucose metabolism plays an important role in patients with acute myocardial infarction, but the clinical significance of glycemic variability (GV) early after the onset of ST-segment elevation myocardial infarction (STEMI) remains to be fully elucidated. METHODS AND RESULTS We prospectively investigated the clinical impact of GV, as determined by a continuous glucose monitoring system (CGMS), on left ventricular remodeling (LVR) assessed by cardiac magnetic resonance imaging (CMR) in 69 patients (63±13 years, 59 men) with a first reperfused STEMI within 12 h of onset. All patients were equipped with a CGMS when in a stable phase after admission and underwent repeat CMR at baseline and 7 months follow-up. Patients were divided into 2 groups according to the mean amplitude of glycemic excursions (MAGE). Patients in the upper tertile of MAGE were categorized as group High (H) and the other two-thirds as group Low (L). LVR was defined as an absolute increase in left ventricular end-diastolic volume index of ≥20%. LVR more frequently occurred in group H than in group L (56% vs. 11%, P<0.001). Multivariate analysis showed the higher MAGE group was an independent predictor of LVR in the chronic phase (odds ratio, 13.999; 95% confidence interval, 3.059 to 64.056; P=0.001). CONCLUSIONS MAGE early after the onset of STEMI identified patients with LVR in the chronic phase.
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Affiliation(s)
- Masaomi Gohbara
- Division of Cardiology, Yokohama City University Medical Center
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AbuShady MM, Mohamady Y, Enany B, Nammas W. Prevalence of prediabetes in patients with acute coronary syndrome: impact on in-hospital outcomes. Intern Med J 2015; 45:183-8. [DOI: 10.1111/imj.12651] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 11/25/2014] [Indexed: 11/29/2022]
Affiliation(s)
- M. M. AbuShady
- Endocrinology Unit; Department of Internal Medicine; Faculty of Medicine; Ain Shams University; Cairo Egypt
| | - Y. Mohamady
- Cardiology Department; Faculty of Medicine; Ain Shams University; Cairo Egypt
| | - B. Enany
- Cardiology Department; Faculty of Medicine; Ain Shams University; Cairo Egypt
| | - W. Nammas
- Cardiology Department; Faculty of Medicine; Ain Shams University; Cairo Egypt
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47
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Natsuaki M, Node K. Glycemic Variability and Cardiac Remodeling in Patients With Acute Myocardial Infarction. Circ J 2015; 79:972-3. [DOI: 10.1253/circj.cj-15-0339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
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48
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Conway R, Byrne D, O'Riordan D, Silke B. Hyponatraemia in Emergency Medical Admissions-Outcomes and Costs. J Clin Med 2014; 3:1220-33. [PMID: 26237600 PMCID: PMC4470179 DOI: 10.3390/jcm3041220] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 10/06/2014] [Accepted: 10/10/2014] [Indexed: 11/30/2022] Open
Abstract
Healthcare systems in the developed world are struggling with the demand of emergency room presentations; the study of the factors driving such demand is of fundamental importance. From a database of all emergency medical admissions (66,933 episodes in 36,271 patients) to St James’ Hospital, Dublin, Ireland, over 12 years (2002 to 2013) we have explored the impact of hyponatraemia on outcomes (30 days in-hospital mortality, length of stay (LOS) and costs). Identified variables, including Acute Illness Severity, Charlson Co-Morbidity and Chronic Disabling Disease that proved predictive univariately were entered into a multivariable logistic regression model to predict the bivariate of 30 days in-hospital survival. A zero truncated Poisson regression model assessed LOS and episode costs and the incidence rate ratios were calculated. Hyponatraemia was present in 22.7% of episodes and 20.3% of patients. The 30 days in-hospital mortality rate for hyponatraemic patients was higher (15.9% vs. 6.9% p < 0.001) and the LOS longer (6.3 (95% CI 2.9, 12.2) vs. 4.0 (95% CI 1.5, 8.2) p < 0.001). Both parameters worsened with the severity of the initial sodium level. Hospital costs increased non-linearly with the severity of initial hyponatraemia. Hyponatraemia remained an independent predictor of 30 days in-hospital mortality, length of stay and costs in the multi-variable model.
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Affiliation(s)
- Richard Conway
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland.
| | - Declan Byrne
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland.
| | - Deirdre O'Riordan
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland.
| | - Bernard Silke
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland.
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Arvia C, Siciliano V, Chatzianagnostou K, Laws G, Quinones Galvan A, Mammini C, Berti S, Molinaro S, Iervasi G. Conventional insulin vs insulin infusion therapy in acute coronary syndrome diabetic patients. World J Diabetes 2014; 5:562-568. [PMID: 25126402 PMCID: PMC4127591 DOI: 10.4239/wjd.v5.i4.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 01/22/2014] [Accepted: 05/19/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate the impact on glucose variability (GLUCV) of an nurse-implemented insulin infusion protocol when compared with a conventional insulin treatment during the day-to-day clinical activity.
METHODS: We enrolled 44 type 2 diabetic patients (n = 32 males; n = 12 females) with acute coronary syndrome (ACS) and randomy assigned to standard a subcutaneous insulin treatment (n = 23) or a nurse-implemented continuous intravenous insulin infusion protocol (n = 21). We utilized some parameters of GLUCV representing well-known surrogate markers of prognosis, i.e., glucose standard deviation (SD), the mean daily δ glucose (mean of daily difference between maximum and minimum glucose), and the coefficient of variation (CV) of glucose, expressed as percent glucose (SD)/glucose (mean).
RESULTS: At the admission, first fasting blood glucose, pharmacological treatments (insulin and/or anti-diabetic drugs) prior to entering the study and basal glycated hemoglobin (HbA1c) were observed in the two groups treated with subcutaneous or intravenous insulin infusion, respectively. When compared with patients submitted to standard therapy, insulin-infused patients showed both increased first 24-h (median 6.9 mmol/L vs 5.7 mmol/L P < 0.045) and overall hospitalization δ glucose (median 10.9 mmol/L vs 9.3 mmol/L, P < 0.028), with a tendency to a significant increase in first 24-h glycaemic CV (23.1% vs 19.6%, P < 0.053). Severe hypoglycaemia was rare (14.3%), and it was observed only in 3 patients receiving insulin infusion therapy. HbA1c values measured during hospitalization and 3 mo after discharge did not differ in the two groups of treatment.
CONCLUSION: Our pilot data suggest that no real benefit in terms of GLUCV is observed when routinely managing blood glucose by insulin infusion therapy in type 2 diabetic ACS hospitalized patients in respect to conventional insulin treatment
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Lazzeri C, Valente S, Gensini GF. Hyperglycemia in Acute Heart Failure: An Opportunity to Intervene? Curr Heart Fail Rep 2014; 11:241-5. [DOI: 10.1007/s11897-014-0205-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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