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Kirmani TA, Singh M, Kumar S, Kumar K, Parkash O, Sagar, Yasmin F, Khan F, Chughtai N, Asghar MS. Plasma random glucose levels at hospital admission predicting worse outcomes in STEMI patients undergoing PCI: A case series. Ann Med Surg (Lond) 2022; 78:103857. [PMID: 35734745 PMCID: PMC9207087 DOI: 10.1016/j.amsu.2022.103857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/19/2022] [Accepted: 05/22/2022] [Indexed: 11/17/2022] Open
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Li M, Gao Y, Guo K, Wu Z, Lao Y, Li J, Huang X, Feng L, Dong J, Yuan Y. Association Between Fasting Hyperglycemia and New-Onset Atrial Fibrillation in Patients With Acute Myocardial Infarction and the Impact on Short- and Long-Term Prognosis. Front Cardiovasc Med 2021; 8:667527. [PMID: 34277729 PMCID: PMC8280294 DOI: 10.3389/fcvm.2021.667527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/27/2021] [Indexed: 01/08/2023] Open
Abstract
Background: The relationship between fasting hyperglycemia (FHG) and new-onset atrial fibrillation (AF) in patients with acute myocardial infarction (AMI) is unclear, and whether their co-occurrence is associated with a worse in-hospital and long-term prognosis than FHG or AF alone is unknown. Objective: To explore the correlation between FHG and new-onset AF in patients with AMI, and their impact on in-hospital and long-term all-cause mortality. Methods: We performed a retrospective cohort study comprising 563 AMI patients. The patients were divided into the FHG group and the NFHG group. The incidence of new-onset AF during hospitalization was compared between the two groups and sub-groups under different Killip grades. Logistic regression was used to assess the association between FHG and new-onset AF. In-hospital mortality and long-term all-cause mortality were compared among patients with FHG, AF, and with both FHG and AF according to 10 years of follow-up information. Results: New-onset AF occurred more frequently in the FHG group than in the NFHG group (21.6 vs. 9.2%, p < 0.001). This trend was observed for Killip grade I (16.6 vs. 6.5%, p = 0.002) and Grade II (17.1 vs. 6.9%, p = 0.005), but not for Killip grade III–IV (40 vs. 33.3%, p = 0.761). Logistic regression showed FHG independently correlated with new-onset AF (OR, 2.56; 95% CI, 1.53–4.30; P < 0.001), and 1 mmol/L increased in fasting glucose was associated with a 5% higher rate of new-onset AF, after adjustment for traditional AF risk factors. AMI patients complicated with both fasting hyperglycemia and AF showed the highest in-hospital mortality and long-term all-cause mortality during an average of 11.2 years of follow-up. Multivariate Cox regression showed FHG combined with AF independently correlated with long-term all-cause mortality after adjustment for other traditional risk factors (OR = 3.13, 95% CI 1.64–5.96, p = 0.001), compared with the group with neither FHG nor new-onset AF. Conclusion: FHG was an independent risk factor for new-onset AF in patients with AMI. AMI patients complicated with both FHG and new-onset AF showed worse in-hospital and long-term all-cause mortality than with FHG or AF alone.
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Affiliation(s)
- Mingxing Li
- Department of Cardiology, Zhongshan People's Hospital, Zhongshan, China
| | - Yingying Gao
- School of Nursing and Health, Henan University, Kaifeng, China
| | - Kai Guo
- Department of Cardiology, Zhongshan People's Hospital, Zhongshan, China
| | - Zidi Wu
- Department of Cardiology, Zhongshan People's Hospital, Zhongshan, China
| | - Yi Lao
- Department of Cardiology, Zhongshan People's Hospital, Zhongshan, China
| | - Jiewen Li
- Department of Cardiology, Zhongshan People's Hospital, Zhongshan, China
| | - Xuansheng Huang
- Department of Cardiology, Zhongshan People's Hospital, Zhongshan, China
| | - Li Feng
- Department of Cardiology, Zhongshan People's Hospital, Zhongshan, China
| | - Jianting Dong
- Department of Cardiology, Zhongshan People's Hospital, Zhongshan, China
| | - Yong Yuan
- Department of Cardiology, Zhongshan People's Hospital, Zhongshan, China
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Gencer B, Rigamonti F, Nanchen D, Klingenberg R, Räber L, Moutzouri E, Auer R, Carballo D, Heg D, Windecker S, Lüscher TF, Matter CM, Rodondi N, Mach F, Roffi M. Prognostic values of fasting hyperglycaemia in non-diabetic patients with acute coronary syndrome: A prospective cohort study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:589-598. [DOI: 10.1177/2048872618777819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background:
Controversy remains regarding the prevalence of hyperglycaemia in non-diabetic patients hospitalised with acute coronary syndrome and its prognostic value for long-term outcomes.
Methods and results:
We evaluated the prevalence of hyperglycaemia (defined as fasting glycaemia ⩾10 mmol/l) among patients with no known diabetes at the time of enrolment in the prospective Special Program University Medicine-Acute Coronary Syndromes cohort, as well as its impact on all-cause death, myocardial infarction, stroke and incidence of diabetes at one year. Among 3858 acute coronary syndrome patients enrolled between December 2009–December 2014, 709 (18.4%) had known diabetes, while 112 (3.6%) of non-diabetic patients had hyperglycaemia at admission. Compared with non-hyperglycaemic patients, hyperglycaemic individuals were more likely to present with ST-elevation myocardial infarction and acute heart failure. At discharge, hyperglycaemic patients were more frequently treated with glucose-lowering agents (8.9% vs 0.66%, p<0.001). At one-year, adjudicated all-cause death was significantly higher in non-diabetic patients presenting with hyperglycaemia compared with patients with no hyperglycaemia (5.4% vs 2.2%, p=0.041) and hyperglycaemia was a significant predictor of one-year mortality (adjusted hazard ratio 2.39, 95% confidence interval 1.03–5.56). Among patients with hyperglycaemia, 9.8% had developed diabetes at one-year, while the corresponding proportion among patients without hyperglycaemia was 1.8% (p<0.001). In multivariate analysis, hyperglycaemia at presentation predicted the onset of treated diabetes at one-year (odds ratio 4.15, 95% confidence interval 1.59–10.86; p=0.004).
Conclusion:
Among non-diabetic patients hospitalised with acute coronary syndrome, a fasting hyperglycaemia of ⩾10 mmol/l predicted one-year mortality and was associated with a four-fold increased risk of developing diabetes at one year.
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Affiliation(s)
- Baris Gencer
- Cardiology Division, Geneva University Hospitals, Switzerland
| | - Fabio Rigamonti
- Cardiology Division, Geneva University Hospitals, Switzerland
- Department of Internal Medicine, University of Genoa, Italy
| | - David Nanchen
- Department of Ambulatory Care and Community Medicine, Lausanne University, Switzerland
| | | | - Lorenz Räber
- Department of Cardiology, University Hospital of Bern, Switzerland
| | - Elisavet Moutzouri
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
- Department of Clinical Research, University of Bern, Switzerland
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - David Carballo
- Cardiology Division, Geneva University Hospitals, Switzerland
| | - Dik Heg
- Department of Clinical Research, University of Bern, Switzerland
| | | | | | | | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
- Department of General Internal Medicine, Bern University Hospital, Switzerland
| | - François Mach
- Cardiology Division, Geneva University Hospitals, Switzerland
| | - Marco Roffi
- Cardiology Division, Geneva University Hospitals, Switzerland
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Gulsen K, Ayca B, Baskurt M, Okcun B, Ersanli MK. Does Tight Glucose Control During the First 24 hours of Hospitalization Reduce Scintigraphic Infarct Size in STEMI Patients? INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2020. [DOI: 10.36660/ijcs.20200020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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5
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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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Bruno RR, Kelm M, Jung C. Spotlight on comorbidities in STEMI patients. Endocrinol Diabetes Metab 2020; 3:e00102. [PMID: 31922029 PMCID: PMC6947710 DOI: 10.1002/edm2.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/27/2019] [Indexed: 01/28/2023] Open
Affiliation(s)
- Raphael Romano Bruno
- Division of Cardiology, Pulmonology, and Vascular Medicine Medical Faculty University Hospital Düsseldorf Dusseldorf Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine Medical Faculty University Hospital Düsseldorf Dusseldorf Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine Medical Faculty University Hospital Düsseldorf Dusseldorf Germany
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Effect of Diabetes Mellitus on Complication Rates of Coronary Artery Bypass Grafting. Am J Cardiol 2019; 124:1389-1396. [PMID: 31481175 DOI: 10.1016/j.amjcard.2019.07.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/23/2019] [Accepted: 07/25/2019] [Indexed: 12/27/2022]
Abstract
Previous studies have shown that diabetes mellitus (DM) is a risk factor for postoperative coronary artery bypass grafting (CABG) complications. More contemporary studies are needed to guide revascularization decisions in DM patients. We performed a single-center study of patients who underwent CABG. Patients with no DM were compared with patients with DM, subgrouped according to whether or not DM was treated with insulin before admission (Insulin and No Insulin Groups). Multivariable logistic regression was used to determine whether DM was a significant predictor of mortality, combined postoperative events, and specific postoperative complications after controlling for other predictive clinical variables. Of 11,590 consecutive patients who underwent CABG, 5,013 (43%) had DM and 6,577 (57%) had no DM. Of the patients with DM, 3,433 (68%) were not treated with insulin and 1,580 (32%) were treated with insulin before admission. Multivariable logistic regression analyses showed that DM was not significantly associated with in-hospital mortality or combined postoperative events after considering other clinical variables. The No Insulin Group was significantly associated with stroke, and the Insulin Group was significantly associated with surgical site infection and new renal failure. In conclusion, this study of consecutively treated CABG patients shows that DM is not a predictor of in-hospital mortality or combined in-hospital postoperative events after adjusting for other clinical factors. DM is a predictor of permanent stroke, surgical site infection, and new renal failure. These findings may help with case selection and management of DM patients undergoing CABG.
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Relationship between Random Blood Glucose, Fasting Blood Glucose, and Gensini Score in Patients with Acute Myocardial Infarction. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9707513. [PMID: 31737681 PMCID: PMC6815616 DOI: 10.1155/2019/9707513] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/19/2019] [Accepted: 09/24/2019] [Indexed: 01/08/2023]
Abstract
Objective To examine the relationship between admission random blood glucose (RBG), fasting blood glucose (FBG), and Gensini score in patients with acute myocardial infarction (AMI) to clarify the effects of RBG and FBG on the severity of coronary artery disease. Method A total of 958 consecutive AMI patients who underwent emergency coronary angiography at the Cardiology Department of Zhongda Hospital (affiliated with Southeast University) were enrolled in this study from January 1, 2016, to December 31, 2018. The Gensini score of each patient was calculated according to the results of coronary angiography. The RBG, FBG, baseline data, hematological indexes, echocardiography parameters, coronary angiography data, and the use of intra-aortic balloon pump (IABP) were recorded. Patients with an RBG level >11.1 mmol/L were classified into the stress hyperglycemia group, and those with an FBG level >7.0 mmol/L were classified into the elevated FBG group. The Gensini scores in the stress hyperglycemia and elevated FBG groups were compared to those in the control group, and correlations between the RBG and FBG levels and the Gensini scores of AMI patients were evaluated. Independent risk factors for the Gensini score were analyzed by multiple linear and multiple logistic regression analyses. Results The Gensini scores of the stress hyperglycemia group and the elevated FBG group were higher than those of the control group. RBG and FBG were positively correlated with the Gensini score, and there were significant differences between RBG and FBG in different Gensini score groups. After adjusting for confounding factors, multiple linear regression analysis showed that sex, diabetes, estimated glomerular filtration rate (eGFR), and FBG were independent risk factors for the Gensini score. Multiple logistic regression analysis showed that age and FBG were independent risk factors in group 2 compared to group 1, eGFR and FBG were independent risk factors in group 3, and eGFR and FBG were independent risk factors in group 4. Diabetes and RBG were not independent risk factors for the Gensini score. Conclusion The Gensini scores of patients in the stress hyperglycemia group and the elevated FBG group were significantly higher than those in the control group. RBG and FBG were positively correlated with the Gensini score in AMI patients, and FBG was an independent risk factor for the Gensini score in AMI patients.
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Hosseini Dehkordi SH, Albu J, Aziz EF, Herzog E. Pathway for the Management of Hyperglycemia in the Cardiac Care Unit. Crit Pathw Cardiol 2018; 16:119-125. [PMID: 29135618 DOI: 10.1097/hpc.0000000000000112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Inpatient hyperglycemia has been associated with increased morbidity and mortality in critically ill patients. Optimal control of blood glucose (BG) levels using insulin infusion protocols has been shown to improve clinical outcomes. Protocols have been developed to prescribe a safe and effective rate of insulin infusion for optimal control of BG levels; however, a major obstacle in their implementation is their complexity. We have revised and updated our previously published pathway for the management of hyperglycemia, which introduces the "wheel" concept for insulin dosing. The "wheel" serves as a treatment guide. It is made up of 6 concentric circles. The core circle represents the goal of BG in critically ill patients, with inner circle showing the actual BG range of the patient. The 4 outer circles correspond to increasing rates of insulin infusion from tier 1 to tier 4. Simple guidelines are provided to facilitate conversion from insulin infusion to a subcutaneous insulin-delivery regimen in preparation for transfer from the cardiac care unit (CCU) setting. Our protocols also provide guidelines for management of diabetic ketoacidosis and hyperosmolar hyperglycemic states while at the same time creates a flowchart for activation of diabetes care team and their involvement in the multidisciplinary care of a patient in CCU with hyperglycemia and/or diabetes mellitus. This pathway provides a comprehensive and detailed, yet simple and practical algorithm for management of hyperglycemia in the CCU.
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Affiliation(s)
- Seyed Hamed Hosseini Dehkordi
- From the *Division of Internal Medicine, Icahn School of Medicine at Mount Sinai St. Luke's-West Hospital Center, New York, NY; †Division of Endocrinology, Icahn School of Medicine at Mount Sinai St. Luke's-West Hospital Center, New York, NY; ‡Division of Electrophysiology, Icahn School of Medicine at Mount Sinai St. Luke's-West Hospital Center, New York, NY; and §Cardiac Care Unit, Icahn School of Medicine at Mount Sinai St. Luke's Hospital. New York, NY
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Adefurin A, Vanderbilt C, Okafor C, Kawai V, Li C, Shah A, Wei WQ, Kurnik D, Stein CM. Alpha2A adrenergic receptor genetic variation contributes to hyperglycemia after myocardial infarction. Int J Cardiol 2016; 215:482-6. [PMID: 27131769 PMCID: PMC4879094 DOI: 10.1016/j.ijcard.2016.04.079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/11/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Acute myocardial infarction (AMI) is frequently associated with transient hyperglycemia even in patients without pre-existing diabetes. Acute stress can lead to increased blood glucose through the effect of catecholamines on alpha2A-adrenergic receptors (α2A-ARs) present in pancreatic islet β-cells. Variation in the gene (ADRA2A) that encodes the α2A-AR affects insulin release and glucose control and may play a particularly important role during times of stress. METHODS We performed a retrospective cohort study using de-identified electronic medical records linked to a DNA repository in 521 Caucasians and 55 African-American non-diabetic patients with AMI. We examined the association between admission blood glucose concentrations and ten selected ADRA2A SNPs in Caucasians. RESULTS Three ADRA2A SNPS were associated with stress-induced hyperglycemia in Caucasians. Individuals homozygous for the rs10885122 variant (n=9) had a 23% lower admission glucose (geometric mean [95% CI], 99 [83-118]mg/dl) compared with non-carriers (121 [118-125] mg/dl; n=401; P=0.001). Admission glucose was 14% higher in rs1800544 variant homozygotes (134 [119-150]mg/dl; n=36) compared to non-carriers (118 [115-121]mg/dl; n=290, P=0.046). Furthermore, homozygotes of the rs553668 variant (n=13) had a 13% higher glucose (133 [110-160]mg/dl) compared to non-carriers (118 [115-122]mg/dl; n=366; P=0.056). Haplotypes including these ADRA2A SNPs were associated with higher admission glucose levels. CONCLUSIONS Three ADRA2A genetic variants are associated with blood glucose and stress-induced hyperglycemia after AMI in Caucasians.
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Affiliation(s)
- Abiodun Adefurin
- Departments of Medicine and Pharmacology, Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Charles Vanderbilt
- Departments of Medicine and Pharmacology, Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Chimalum Okafor
- Departments of Medicine and Pharmacology, Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Vivian Kawai
- Departments of Medicine and Pharmacology, Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Chun Li
- Department of Epidemiology and Biostatistics, Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, United States
| | - Anushi Shah
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
| | - Daniel Kurnik
- Departments of Medicine and Pharmacology, Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA; Clinical Pharmacology Unit, Rambam Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - C Michael Stein
- Departments of Medicine and Pharmacology, Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
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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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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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Temporal trends in management and outcome of diabetic and non-diabetic patients with acute coronary syndrome (ACS): Residual risk of long-term mortality persists. Int J Cardiol 2015; 179:546-51. [DOI: 10.1016/j.ijcard.2014.10.116] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 10/21/2014] [Indexed: 12/11/2022]
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Arbel Y, Shmueli H, Halkin A, Berliner S, Shapira I, Herz I, Havakuk O, Shacham Y, Rabinovich I, Keren G, Finkelstein A, Banai S. Hyperglycemia in patients referred for cardiac catheterization is associated with preexisting diabetes rather than a stress-related phenomenon: a prospective cross-sectional study. Clin Cardiol 2014; 37:479-84. [PMID: 24798003 PMCID: PMC6649544 DOI: 10.1002/clc.22290] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 03/22/2014] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND An increased serum glucose level in patients with acute coronary syndrome (ACS) is associated with adverse clinical outcome. This hyperglycemia has been attributed, at least in part, to acute stress reaction. Our objective was to determine whether hyperglycemia is a stress-related phenomenon or whether it represents a more sustained and possibly significant background dysglycemia. HYPOTHESIS Hyperglycemia in patients undergoing coronary angiography is related to background dysglycemia. METHODS Blood samples were obtained at the time of cardiac catheterization. Patients with hemoglobin A1c >6.5% were excluded to avoid patients with chronic glucose levels above 135 mg/dL. A logistic regression model was created to assess the influence of different variables on hyperglycemia (glucose levels above 140 mg/dL). We also evaluated the effect of glucose levels above 140 mg/dL on major adverse cardiovascular events (MACEs) up to 36 months. RESULTS There were 2554 consecutive patients prospectively recruited. Serum glucose levels above 140 mg/dL was a strong predictor of MACE (hazard ratio: 2.2, 95% confidence interval [CI]: 1.3-3.6, P = 0.002). Both diabetes mellitus and ACS were associated with hyperglycemia (glucose levels above 140 mg/dL). Nevertheless, the incidence of hyperglycemia was doubled in diabetic patients (odds ratio [OR]: 9.4, 95% CI: 3.9-22.4, P < 0.001) compared with patients with ACS (OR: 4.6, 95% CI: 2.3-9.0, P < 0.001). Combining both conditions was associated with a high likelihood of elevated glucose levels (OR: 15.5, 95% CI: 7.4-32.9, P < 0.001). CONCLUSIONS Hyperglycemia in patients undergoing cardiac catheterization is a strong predictor of adverse outcome. It is mainly related to background dysglycemia and to a lesser extent to the acute stress accompanying ACS.
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Affiliation(s)
- Yaron Arbel
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated with the Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Hezzy Shmueli
- Department of Internal Medicine “D” and “E”, Tel Aviv Medical Center, Tel Aviv, affiliated with the Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Amir Halkin
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated with the Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Shlomo Berliner
- Department of Internal Medicine “D” and “E”, Tel Aviv Medical Center, Tel Aviv, affiliated with the Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Itzhak Shapira
- The Tel Aviv Sourasky Medical Center and Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Itzhak Herz
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated with the Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Ofer Havakuk
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated with the Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Yacov Shacham
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated with the Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Itay Rabinovich
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated with the Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Gad Keren
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated with the Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Ariel Finkelstein
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated with the Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated with the Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
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15
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Lønborg J, Vejlstrup N, Kelbæk H, Nepper-Christensen L, Jørgensen E, Helqvist S, Holmvang L, Saunamäki K, Bøtker HE, Kim WY, Clemmensen P, Treiman M, Engstrøm T. Impact of acute hyperglycemia on myocardial infarct size, area at risk, and salvage in patients with STEMI and the association with exenatide treatment: results from a randomized study. Diabetes 2014; 63:2474-85. [PMID: 24584550 DOI: 10.2337/db13-1849] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Hyperglycemia upon hospital admission in patients with ST-segment elevation myocardial infarction (STEMI) occurs frequently and is associated with adverse outcomes. It is, however, unsettled as to whether an elevated blood glucose level is the cause or consequence of increased myocardial damage. In addition, whether the cardioprotective effect of exenatide, a glucose-lowering drug, is dependent on hyperglycemia remains unknown. The objectives of this substudy were to evaluate the association between hyperglycemia and infarct size, myocardial salvage, and area at risk, and to assess the interaction between exenatide and hyperglycemia. A total of 210 STEMI patients were randomized to receive intravenous exenatide or placebo before percutaneous coronary intervention. Hyperglycemia was associated with larger area at risk and infarct size compared with patients with normoglycemia, but the salvage index and infarct size adjusting for area at risk did not differ between the groups. Treatment with exenatide resulted in increased salvage index both among patients with normoglycemia and hyperglycemia. Thus, we conclude that the association between hyperglycemia upon hospital admission and infarct size in STEMI patients is a consequence of a larger myocardial area at risk but not of a reduction in myocardial salvage. Also, cardioprotection by exenatide treatment is independent of glucose levels at hospital admission. Thus, hyperglycemia does not influence the effect of the reperfusion treatment but rather represents a surrogate marker for the severity of risk and injury to the myocardium.
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Affiliation(s)
- Jacob Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Nepper-Christensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Erik Jørgensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Steffen Helqvist
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kari Saunamäki
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Peter Clemmensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marek Treiman
- Department of Biomedical Sciences and The Danish National Foundation Research Centre for Heart Arrhythmia, Copenhagen University, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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16
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Meloni L, Montisci R, Sau L, Boi A, Marini A, Ruscazio M. Admission hyperglycemia in acute myocardial infarction: possible role in unveiling patients with previously undiagnosed diabetes mellitus. J Cardiovasc Med (Hagerstown) 2013; 14:821-6. [PMID: 23422887 DOI: 10.2459/jcm.0b013e32835ec72b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIM The aim of this study was to investigate the relationship between admission plasma glucose levels and abnormal glucose metabolism in patients with acute myocardial infarction (AMI) without a previous diagnosis of diabetes mellitus. METHODS A total of 285 nondiabetic patients admitted with AMI were screened for glucometabolic disorders by using fasting glucose measurements during hospital stay or an oral glucose tolerance test on discharge. Patients diagnosed as having diabetes mellitus were followed-up for a mean of 60 ± 33 months in order to confirm the diagnosis. RESULTS There was a graded relationship between admission glucose levels and the prevalence of newly detected diabetes mellitus (group 1, <140 mg/dl: 12%; group 2, ≥140 < 200 mg/dl: 40%; group 3, ≥200 mg/dl: 70.3%; P < 0.0001). The admission glucose level of at least 144 mg/dl was the best predictor of newly detected diabetes mellitus during hospitalization (area under the curve 0.78, P = 0.0001). In multivariable analysis, patients with admission hyperglycemia had greater odds of having newly detected diabetes mellitus (odds ratio 6.6, 95% confidence interval 2.7-16.3, P = 0.0001). Diabetes mellitus was confirmed in the long-term follow-up in 78% of patients diagnosed as having diabetes mellitus during hospitalization. CONCLUSION Our finding suggests a relationship between admission glucose and previously undetected diabetes mellitus in nondiabetic patients presenting AMI. Acute hyperglycemia may help to identify high-risk patients for diabetes mellitus, who should be screened initially for glucometabolic disorders, then closely monitored and appropriately treated to improve outcome.
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Affiliation(s)
- Luigi Meloni
- Clinical Cardiology, San Giovanni di Dio Hospital, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
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17
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Deckers JW, van Domburg RT, Akkerhuis M, Nauta ST. Relation of admission glucose levels, short- and long-term (20-year) mortality after acute myocardial infarction. Am J Cardiol 2013; 112:1306-10. [PMID: 23866731 DOI: 10.1016/j.amjcard.2013.06.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 06/04/2013] [Accepted: 06/04/2013] [Indexed: 01/08/2023]
Abstract
We examined temporal trends in mortality after myocardial infarction from 1985 to 2008 depending on admission glucose levels. We included 11,324 consecutive patients admitted to our intensive coronary care unit for myocardial infarction from 1985 to 2008. Patients were categorized into normal, mild, and severe hyperglycemia groups (admission glucose levels <140, 140 to 200, and ≥200 mg/dl, respectively). Temporal trends were determined using 3 groups: 1985 to 1990, 1990 to 2000, and 2000 to 2008. The prevalence of hyperglycemia increased from 26% in the 1980s to 49% in the 2000s. The prevalence of hyperglycemia primarily increased in patients without diabetes. Kaplan-Meier mortality was 4%, 8%, and 17% at 30 days and 64%, 71%, and 82% at 20 years in patients with normal, mild, and severe hyperglycemia, respectively. Compared with normal admission glucose level, adjusted 30-day mortality was 3.6-fold greater (95% confidence interval 2.9 to 4.3) in patients with severe hyperglycemia. This association was not dependent on diabetic status (p for interaction = 0.43) but was dependent on the decade of hospitalization with a stronger association from 2000 to 2008 (adjusted odds ratio 7.7, 95% confidence interval 5.4 to 11, p for interaction <0.001). Compared with diabetes, hyperglycemia was a better discriminator for 30-day mortality. Mortality at 30 days decreased from 1985 to 2008, however, it decreased less in patients with hyperglycemia compared with those with normoglycemia. In conclusion, elevated admission glucose levels are common in patients with myocardial infarction and are strongly associated with increased mortality. Mortality decreased less from 1985 to 2008 in patients with hyperglycemia compared with those with normoglycemia. Efforts that establish optimal treatment for these patients remain warranted.
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18
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Yang SW, Zhou YJ, Tian XF, Pan GZ, Liu YY, Zhang J, Guo ZF, Chen SY, Gao ST, Du J, Jia DA, Fang Z, Hu B, Han HY, Gao F, Hu DY, Xu YY. Association of dysglycemia and all-cause mortality across the spectrum of coronary artery disease. Mayo Clin Proc 2013; 88:930-41. [PMID: 24001485 DOI: 10.1016/j.mayocp.2013.05.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 04/11/2013] [Accepted: 05/02/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To assess the association between fasting plasma glucose (FPG) and all-cause mortality across the spectrum of coronary artery disease (CAD). PATIENTS AND METHODS The study included 18,999 patients during a study period of April 1, 2004, through October 31, 2010. The primary end points were in-hospital and follow-up all-cause mortality. According to the quartiles of FPG levels, patients were categorized into 4 groups: quartile 1, less than 5.1 mmol/L; quartile 2, 5.1 to less than 5.9 mmol/L; quartile 3, 5.9 to less than 7.5 mmol/L; and quartile 4, 7.5 mmol/L or greater. The conversion factor for units of plasma glucose is 1.00 mmol/L equals 18 mg/dL. Presented as mg/dL, the 4 quartile ranges of plasma glucose concentrations used in our data analysis are ≤90.0 mg/dL, 90.1-106.0 mg/dL, 106.1 mg/dL-135.0 mg/dL and ≥135.1 mg/dL. Quartile 1 was recognized as the lower glycemic group, quartiles 2 and 3 as the normoglycemic groups, and quartile 4 as the higher glycemic group. RESULTS In patients with acute myocardial infarction, all-cause mortality for the dysglycemic groups was higher than for the normoglycemic groups: in-hospital mortality for quartiles 1, 2, 3, and 4 was 1.0%, 0.9%, 0.2%, and 1.5%, respectively (P=.001); follow-up mortality for quartiles 1, 2, 3, and 4 was 1.7%, 0.9%, 0.3%, and 1.8%, respectively (P<.001). In patients with stable CAD, no significant differences in mortality were found among groups. However, in patients with unstable angina pectoris, the normoglycemic groups had lower follow-up mortality and roughly equal in-hospital mortality compared with the dysglycemic groups. After adjusting for confounding factors, this observation persisted. CONCLUSION The association between lower FPG level and mortality differed across the spectrum of CAD. In patients with acute myocardial infarction, there was a U-shaped relationship. In patients with stable CAD or unstable angina pectoris, mildly to moderately decreasing FPG level was associated with neither higher nor lower all-cause mortality.
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Affiliation(s)
- Shi-Wei Yang
- 12th Ward, Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing, China
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19
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Impact of hyperglycemia in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: The HORIZONS-AMI trial. Int J Cardiol 2013; 167:2572-9. [DOI: 10.1016/j.ijcard.2012.06.054] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 06/16/2012] [Indexed: 01/08/2023]
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20
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Lazzeri C, Valente S, Chiostri M, Attanà P, Mattesini A, Gensini GF. Acute insulin resistance assessed by the homeostatic model assessment in acute coronary syndromes without previously known diabetes. Angiology 2013; 65:519-24. [PMID: 23650645 DOI: 10.1177/0003319713489018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We assessed the incidence and the prognostic role for early death of acute insulin resistance (by means of homeostatic model assessment [HOMA] index) in 1350 patients with acute coronary syndrome (ACS) consecutively admitted to our intensive cardiac care unit (ICCU). The incidence of HOMA positivity was 5% (68 of 1350), with the highest percentage of HOMA positivity among ST-segment elevation myocardial infarction (STEMI). Patients with HOMA positivity showed a higher body mass index (P = .003), lower values of admission and discharge left-ventricular ejection fraction (LVEF; P < .001 and P = .003, respectively), and higher levels of peak troponin I (Tn I; P < .001). The HOMA index was an independent predictor of early death (odds ratio 1.724, 95% confidence interval 1.252-2.375, P = .001). In patients with ACS and without previously known diabetes, acute insulin resistance (HOMA index) is associated with a larger myocardial damage (ie, higher values of peak Tn I and lower LVEF) and a greater inflammatory activation (indicated by correlation with leukocyte count). The HOMA positivity was an independent predictor of in-ICCU mortality.
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Affiliation(s)
- Chiara Lazzeri
- Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Serafina Valente
- Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marco Chiostri
- Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Paola Attanà
- Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alessio Mattesini
- Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Gian Franco Gensini
- Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Steg G, James SK, Atar D, Badano LP, Blomstrom Lundqvist C, A. Borger M, di Mario C, Dickstein K, Ducrocq G, Fernández-Avilés F, H. Gershlick A, Giannuzzi P, Halvorsen S, Huber K, Juni P, Kastrati A, Knuuti J, J. Lenzen M, W. Mahaffey K, Valgimigli M, van’t Hof A, Widimsky P, Zahger D, J. Bax J, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Astin F, Astrom-Olsson K, Budaj A, Clemmensen P, Collet JP, Fox KA, Fuat A, Gustiene O, Hamm CW, Kala P, Lancellotti P, Pietro Maggioni A, Merkely B, Neumann FJ, Piepoli MF, Werf FVD, Verheugt F, Wallentin L. Guía de práctica clínica de la ESC para el manejo del infarto agudo de miocardio en pacientes con elevación del segmento ST. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.10.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Kushner FG, Ohman EM, Stevenson WG, Yancy CW. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2012; 127:e362-425. [PMID: 23247304 DOI: 10.1161/cir.0b013e3182742cf6] [Citation(s) in RCA: 1071] [Impact Index Per Article: 89.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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23
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O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2012; 61:e78-e140. [PMID: 23256914 DOI: 10.1016/j.jacc.2012.11.019] [Citation(s) in RCA: 2191] [Impact Index Per Article: 182.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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24
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Eitel I, Hintze S, de Waha S, Fuernau G, Lurz P, Desch S, Schuler G, Thiele H. Prognostic impact of hyperglycemia in nondiabetic and diabetic patients with ST-elevation myocardial infarction: insights from contrast-enhanced magnetic resonance imaging. Circ Cardiovasc Imaging 2012; 5:708-18. [PMID: 23051889 DOI: 10.1161/circimaging.112.974998] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Hyperglycemia on admission is associated with increased mortality rates in patients with ST-elevation myocardial infarction (STEMI). However, data regarding the relationship between hyperglycemia and myocardial damage in STEMI are scarce. The aim of this study was to determine the relationship of diabetes mellitus status and hyperglycemia on myocardial damage assessed by cardiovascular magnetic resonance imaging and to evaluate the long-term prognostic significance of hyperglycemia in a high-risk STEMI population. METHODS AND RESULTS Glucose levels were determined on admission in 411 consecutive STEMI patients reperfused by primary angioplasty. Patients were categorized on the basis of diabetes mellitus status and admission glucose level. Magnetic resonance imaging was performed for assessment of infarct size and microvascular obstruction. The primary clinical end point was the occurrence of major adverse cardiovascular events at long-term follow-up. STEMI patients with pre-existing diabetes mellitus were at greater risk for major adverse cardiovascular events (32% versus 11%; P<0.001) despite having similar infarct sizes and extent of reperfusion injury than nondiabetic patients. Glycemic status on admission was associated with greater myocardial damage and an increased risk for major adverse cardiovascular events (P<0.001). In nondiabetic patients, the risk of severe myocardial injury started to rise once admission glucose exceeded 7.8 mmol/L, whereas the threshold was higher among patients with diabetes mellitus (≥11.1 mmol/L). CONCLUSIONS The higher mortality rate in diabetic versus nondiabetic STEMI patients is not explained by more pronounced myocardial damage. Hyperglycemia on admission is associated with greater myocardial injury and an increased risk of major adverse cardiovascular events at long-term follow-up. However, hyperglycemia has a stronger relationship to myocardial injury in nondiabetic compared with diabetic patients.
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Affiliation(s)
- Ingo Eitel
- Department of Internal Medicine-Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
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25
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Lazzeri C, Valente S, Chiostri M, Attanà P, Picariello C, Gensini GF. The prognostic role of in-hospital peak glycemia in stemi patients with and without diabetes. Acta Diabetol 2012; 49:379-86. [PMID: 22008949 DOI: 10.1007/s00592-011-0343-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 10/05/2011] [Indexed: 01/04/2023]
Abstract
Due to the lack of appropriately designed randomized trials, the definitive answer in regard to the prognostic role of in-hospital glucose values in patients with AMI is lacking. We prospectively assessed the prognostic role of in-hospital peak glycemia (≤1.40, 141-180 and >180 g/l) in 611 consecutive STEMI patients (diabetic and without previously known diabetes) submitted to percutaneous coronary intervention. One hundred and fifteen (18.8%) were diabetic and the remaining 496 (81.2%) without previously known diabetes. At multivariable logistic regression analysis, peak glycemia was an independent predictor for in-ICCU death in the overall population and in patients without previously known diabetes. At follow-up, in the overall population (as well as in diabetic and non-diabetic patients), patients with peak glycemia >1.8 g/l showed the lowest survival rate, those with peak glycemia <1.4 g/l the highest and patients with peak glycemia >1.4 and <1.8 g/l intermediate survival rates. In-hospital peak glycemia is an independent predictor for early death in patients without previously known diabetes, but not in diabetic STEMI patients. At follow-up, in-hospital peak glycemia is able to affect long-term survival in diabetic and non-diabetic patients. Our data underscore strongly suggest that different glucose targets and thresholds may be pursued in diabetic and non-diabetic STEMI patients.
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Affiliation(s)
- Chiara Lazzeri
- Intensive Cardiac Care Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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26
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Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, Di Mario C, Dickstein K, Ducrocq G, Fernandez-Aviles F, Gershlick AH, Giannuzzi P, Halvorsen S, Huber K, Juni P, Kastrati A, Knuuti J, Lenzen MJ, Mahaffey KW, Valgimigli M, van 't Hof A, Widimsky P, Zahger D. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012; 33:2569-619. [PMID: 22922416 DOI: 10.1093/eurheartj/ehs215] [Citation(s) in RCA: 3661] [Impact Index Per Article: 305.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
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- AP-HP, Hôpital Bichat / Univ Paris Diderot, Sorbonne Paris-Cité / INSERM U-698, Paris, France.
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Aguilar D. Glycated Hemoglobin as a Prognostic Risk Marker in Nondiabetic Patients After Acute Myocardial Infarction. Circulation 2011; 124:666-8. [DOI: 10.1161/circulationaha.111.043877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David Aguilar
- From the Winters Center for Heart Failure Research and Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
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