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Yang X, Su G, Zhang T, Yang H, Tao H, Du X, Dong J. Comparison of admission glycemic variability and glycosylated hemoglobin in predicting major adverse cardiac events among type 2 diabetes patients with heart failure following acute ST-segment elevation myocardial infarction. J Transl Int Med 2024; 12:188-196. [PMID: 38978967 PMCID: PMC11229884 DOI: 10.2478/jtim-2024-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024] Open
Abstract
Background and Objectives Hyperglycemia is associated with adverse outcomes in patients with acute myocardial infarction (AMI) as well as in patients with heart failure. However, the significance of admission glycemic variability (GV) in predicting outcomes among diabetes patients with heart failure (HF) following acute ST-segment elevation myocardial infarction (ASTEMI) remains unclear. This study aims to explore the prognostic value of admission GV and admission glycosylated hemoglobin (HbA1c) levels in individuals diagnosed with type 2 diabetes and HF following ASTEMI. Methods We measured GV and HbA1c upon admission in 484 consecutive patients diagnosed with type 2 diabetes and HF following ASTEMI. GV, indicated as the mean amplitude of glycemic excursions (MAGE), was assessed utilizing a continuous glucose monitoring system (CGMS). admission MAGE values were categorized as < 3.9 or ≥ 3.9 mmol/L, while HbA1c levels were classified as < 6.5 or ≥ 6.5%. Participants were followed up prospectively for 12 months. The relationship of admission MAGE and HbA1c to the major adverse cardiac event (MACE) of patients with type 2 diabetes and HF following ASTEMI was analyzed. Results Among the 484 enrolled patients, the occurrence of MACE differed significantly based on MAGE categories (< 3.9 vs. ≥ 3.9 mmol/L), with rates of 13.6% and 25.3%, respectively (P = 0.001). While MACE rates varied by HbA1c categories (< 6.5 vs. ≥ 6.5%) at 15.7% and 21.8%, respectively (P = 0.086). Patients with higher MAGE levels exhibited a notably elevated risk of cardiac mortality and an increased incidence of HF rehospitalization. The Kaplan-Meier curves analysis demonstrated a significantly lower event-free survival rate in the high MAGE level group compared to the low MAGE level group (log-rank test, P < 0.001), while HbA1c did not exhibit a similar distinction. In multivariate analysis, high MAGE level was significantly associated with incidence of MACE (hazard ratio 3.645, 95% CI 1.287-10.325, P = 0.015), whereas HbA1c did not demonstrate a comparable association (hazard ratio 1.075, 95% CI 0.907-1.274, P = 0.403). Conclusions Elevated admission GV emerges as a more significant predictor of 1-year MACE in patients with type 2 diabetes and HF following ASTEMI, surpassing the predictive value of HbA1c.
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Affiliation(s)
- Xiuxiu Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Gong Su
- Department of Cardiology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing 100049, China
| | - Tao Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Hongxia Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Hong Tao
- Department of Endocrinology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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Sun C, Zhou JH, Huang YL, Ning YL, Xu XH. The optimal blood glucose is significantly associated with lower mortality in critically ill patients with cardiogenic shock: an analysis revealed with time series blood glucose records. Eur J Med Res 2024; 29:129. [PMID: 38368401 PMCID: PMC10874009 DOI: 10.1186/s40001-024-01724-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/10/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND The optimal blood glucose (BG) level for patients with cardiogenic shock in the intensive care unit (ICU) remains unclear. Studies have found that both excessively high and low BG levels contribute to adverse cardiovascular events. Our study aims to investigate the optimal BG level for critically ill patients with cardiogenic shock and evaluate the effects of optimal BG on the prognosis of patients. METHODS A total of 2013 patients with cardiogenic shock obtained from the Medical Information Mart for Intensive Care (MIMIC) IV database were included in the final cohort for our retrospective observational study for data analysis. The exposure was time-weighted average BG (TWA-BG), which was calculated by the time-series BG records and corresponding time stamps of patients with cardiogenic shock during their stay in the ICU. The cut-off value of TWA-BG was identified by the restricted cubic spline curve and included patients were categorized into three groups: low TWA-BG group (TWA-BG ≤ 104 mg/dl), optimal TWA-BG group (104 < TWA-BG ≤ 138 mg/dl), and high TWA-BG group (TWA-BG > 138 mg/dl). The primary outcome was 28-day mortality, and the secondary outcomes were ICU and in-hospital mortality. We performed the log-rank test to detect whether there is a difference in mortality among different groups in the original cohort. Multiple distinct models were employed to validate the robustness of the results. RESULTS Our study revealed that the optimal BG level for critically ill patients with cardiogenic shock is 104-138 mg/dl. Compared to the optimal TWA-BG group, the low TWA-BG group (hazard ratio (HR): 1.67, 95% confidence interval (CI): 1.19-2.33, p = 0.002) and high TWA-BG group (HR: 1.72, 95% CI: 1.46-2.03, p < 0.001) exhibited higher 28-day mortality. Similarly, the low TWA-BG group and high TWA-BG group demonstrated higher risks in terms of ICU mortality (low TWA-BG group: HR: 2.30, 95% CI: 1.40-3.79, p < 0.001; high TWA-BG group: HR: 1.77, 95% CI: 1.45-2.17, p < 0.001) and in-hospital mortality (low TWA-BG group: HR: 1.73, 95% CI: 1.19-2.51, p = 0.001; high TWA-BG group: HR: 1.64, 95% CI: 1.38-1.95, p < 0.001). Sensitivity analysis conducted through propensity score matching and the subgroup analysis further substantiated the robustness of the results. CONCLUSION The optimal BG level for patients with cardiogenic shock is 104-138 mg/dl. BG levels below 104 mg/dl and above 138 mg/dl were associated with a less favorable prognosis.
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Affiliation(s)
- Ce Sun
- Department of Critical Care Medicine, Meizhou Hospital of Guangzhou University of Chinese Medicine, Meizhou, China
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ji-Hong Zhou
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Pulmonary and Critical Care Medicine (PCCM), Bao'an District Hospital of Chinese Medicine, Shenzhen, China
| | - Yan-Ling Huang
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Pulmonary and Critical Care Medicine (PCCM), Bao'an District Hospital of Chinese Medicine, Shenzhen, China
| | - Yi-Le Ning
- The First Clinical School, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Xiang-Hui Xu
- Department of Critical Care Medicine, Bao'an District Hospital of Chinese Medicine, Shenzhen, China.
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Shi FH, Yu BB, Shen L, Xu L, Jiang YH, Gu ZC, Lin HW, Li H. The Importance of Clinical Pharmacists in Improving Blood Glucose and Lipid Levels in Patients with Diabetes and Myocardial Infarction. Diabetes Metab Syndr Obes 2023; 16:2733-2744. [PMID: 37706215 PMCID: PMC10496847 DOI: 10.2147/dmso.s425960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023] Open
Abstract
Purpose The aim of this study was to evaluate whether intervention by clinical pharmacists can improve blood glucose and lipid levels in diabetic patients with complex medical conditions. Methods The retrospective database included 138 patients with diabetes who had presented with acute myocardial infarction (AMI) between January 2019 and October 2021. Blood glucose and lipid levels were measured within 12 weeks and 78 weeks of follow-up. Propensity score matching (PSM) was used to balance the confounding effects of patients' characteristics. Results A total of 138 eligible patients were assigned to either the intervention group (n = 47) or the usual care group (n = 91). After the intervention, there were significant improvements in blood glucose (glycosylated hemoglobin-HbA1C % from 9.0 to 8.3; fasting blood glucose-FBG mmol/L from 11.3 to 7.1; postprandial blood glucose-PBG mmol/L from 17.0 to 12.1; p < 0.001) and lipid levels (total cholesterol-TC from 4.9 to 3.5, low-density lipoprotein cholesterol-LDL-C from 3.0 to 1.8, p < 0.001, mmol/L) in both follow-up periods. The blood glucose effects were most pronounced in the PBG control rate (76.9% vs 54.0%) before PSM, while HbA1C% and PBG control rate after PSM were significantly higher in the intervention group (HbA1C% rate: 65.6% vs 38.5%; PBG rate: 79.2% vs 45.8%; p < 0.05, intervention vs non-intervention). Subgroup analysis further confirmed the improvement of blood glucose and lipid mainly in patients with higher baseline FBG (≧10mmol/L) and moderate follow-up duration (4-12 weeks). Conclusion The intervention of clinical pharmacists in multidisciplinary team can significantly improve blood glucose and lipid levels in complex type 2 diabetic patients, especially those with high baseline FBG and moderate follow-up durations.
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Affiliation(s)
- Fang-Hong Shi
- Department of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Bin-Bin Yu
- Department of Pharmacy, Huangyan Hospital of Wenzhou Medical University, Taizhou First People’s Hospital, Zhejiang, People’s Republic of China
| | - Long Shen
- Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Li Xu
- Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yi-Hong Jiang
- Department of Endocrinology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Zhi-Chun Gu
- Department of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Hou-Wen Lin
- Department of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Hao Li
- Clinical Research Ward, Clinical Research Center, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
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Mert İlker H, Faysal S, Ahmet Çağdaş Y, Murat S, Tufan Ç. Prognostic value of Intermountain Risk Score for short- and long-term mortality in patients with cardiogenic shock. Coron Artery Dis 2023; 34:154-159. [PMID: 36720024 DOI: 10.1097/mca.0000000000001219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is a lack of current research examining the predictive value of the Intermountain Risk Score (IMRS) in patients with ST-segment elevation myocardial infarction (STEMI) caused by cardiogenic shock. Therefore, the purpose of this research was to investigate the ability of IMRS to predict short- and long-term mortality in patients with cardiogenic shock triggered by STEMI. METHODS The participants included 492 consecutive cardiogenic shock patients who underwent primary percutaneous coronary intervention following STEMI. The patients were separated into two groups depending on their survival status. The groups' baseline characteristics, laboratory data, echocardiographic variables, and risk assessments were then compared. Next, the IMRS score was tested for its ability to predict both short- and long-term mortality. In order to assess its accuracy, the prognostic value of the IMRS was also compared that of the SYNTAX score II (SSII). RESULTS After adjustment for the characteristics in the univariable study, multivariable Cox regression analysis indicated that the IMRS and SSII were both independently associated with short- and long-term mortality in STEMI patients with cardiogenic shock. However, the receiver operating characteristic curves indicated that the IMRS outperformed the SSII in terms of predicting both short- and long-term mortality. CONCLUSION This preliminary investigation showed that IMRS can predict both short- and long-term mortality in individuals with STEMI accompanied by cardiogenic shock.
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Affiliation(s)
- Hayiroğlu Mert İlker
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul
| | - Saylik Faysal
- Department of Cardiology, Van Training and Research Hospital, Van
| | - Yumurtaş Ahmet Çağdaş
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul
| | - Selçuk Murat
- Department of Cardiology, Haydarpasa Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Çinar Tufan
- Department of Cardiology, Haydarpasa Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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Yuan Y, Tao J, Shen X, Cheng H, Dong X, Muyesai N, Wang Z, Li N. Elevated random glucose levels at admission are associated with all-cause mortality and cardiogenic shock during hospitalisation in patients with acute myocardial infarction and without diabetes: A retrospective cohort study. Diabetes Metab Res Rev 2023; 39:e3617. [PMID: 36729039 DOI: 10.1002/dmrr.3617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 11/02/2022] [Accepted: 11/28/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Elevated glucose levels at admission are associated with a worse prognosis in patients with acute myocardial infarction (AMI); additionally, such elevation has a higher prognostic value for patients without diabetes. METHODS We retrospectively recruited 2412 AMI patients without diabetes from 1 August 2011 to 10 January 2022. The primary outcome was all-cause mortality during hospitalisation, and the secondary outcomes were cardiogenic shock, ventricular tachycardia, ventricular fibrillation, atrioventricular block and new stroke. RESULTS The mean age of participants was 65 years and 78.6% were male. Of the 2412 patients, all-cause mortality occurred in 236 patients (9.8%) during hospitalisation. In multivariate-adjusted models that corrected for variable weights, the risk of all-cause mortality increased with an increase in random glucose levels at admission; specifically, the risk of all-cause mortality increased per 1 mg/dL (odds ratio [OR] 1.006, 95% confidence interval [CI]: 1.004-1.008), per 9 mg/dL (OR: 1.06, 95% CI: 1.04-1.08), and per 18 mg/dL (OR: 1.12, 95% CI: 1.07-1.16) increases in admission glucose levels. When admission glucose levels were expressed as a categorical variable, increased levels of glucose (relative to the reference glucose value <140 mg/dL) led to an increased risk of all-cause mortality; specifically, the OR of all-cause mortality for 140-200 mg/dL glucose was 1.55 (95% CI: 1.09-2.17) and the OR for glucose >200 mg/dL was 3.08 (95% CI: 2.00-4.62) (P for trend <0.001). The risk of cardiogenic shock also increased with glucose levels with an OR of 1.68 (95% CI: 1.21-2.31) for 140-200 mg/dL glucose and an OR of 3.72 (95% CI: 2.50-5.46) for >200 mg/dL, compared with that of glucose <140 mg/dL. In multivariate-adjusted spline regression models, an increased risk of all-cause mortality was observed in patients with glucose ≥122 mg/dL (OR: 1.81, 95% CI: 1.38-2.38, p < 0.001) compared with the reference cohort. Furthermore, patients with glucose ≥111 mg/dL (OR: 2.36, 95% CI: 1.80-3.12) had a higher risk of cardiogenic shock than patients with glucose <111 mg/dL. CONCLUSIONS Patients with AMI and without diabetes who had elevated random glucose levels at admission had a higher risk of all-cause mortality and cardiogenic shock during hospitalisation. In particular, patients with glucose ≥122 mg/dL had an increased risk of all-cause mortality, and those with glucose ≥111 mg/dL had an increased risk of cardiogenic shock.
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Affiliation(s)
- Yujuan Yuan
- People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Jing Tao
- People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Xin Shen
- People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Hui Cheng
- People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Xiangyu Dong
- People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Nijiati Muyesai
- People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Zhao Wang
- People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Nanfang Li
- People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
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Hao Q, Yuanyuan Z, Lijuan C. The Prognostic Value of the Triglyceride Glucose Index in Patients With Acute Myocardial Infarction. J Cardiovasc Pharmacol Ther 2023; 28:10742484231181846. [PMID: 37335126 DOI: 10.1177/10742484231181846] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Objective: The triglyceride-glucose (TyG) index is a simple and reliable surrogate for insulin resistance. Recent studies have suggested that the TyG index is an independent predictor of cardiovascular disease. However, the prognostic value of the TyG index in patients with acute myocardial infarction (AMI) remains uncertain. Thus, this study aimed to evaluate the prognostic value of the TyG index in patients with AMI. Methods: AMI patients admitted to Zhongda Hospital from 2018 to 2020 were successively enrolled. After screening the inclusion criteria, 1144 patients were divided into three groups according to the tertiles of the TyG index distribution. Patients were followed up for 1 year as outpatients or contacted via telephone, and the occurrence and timing of all-cause deaths were recorded. Results: The TyG index was significantly correlated with heart failure (HF) in AMI patients. Patients with a high TyG index (group 3) (odds ratio: 9.070, 95% confidence interval [CI] 4.359-18.875, P<.001) had a significantly higher incidence of HF compared with patients with median TyG index (group 2). Similarly, the incidence of all-cause death in group 3 was significantly higher than that in group 2 during the 1-year follow-up (hazard ratio: 2.996, 95% CI 1.058-8.487, P = .039). Conclusion: The TyG index is closely related to HF and may be a valuable indicator to predict the long-term prognosis of patients with AMI.
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Affiliation(s)
- Qian Hao
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Zhao Yuanyuan
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Chen Lijuan
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
- Department of Cardiology, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
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Correlation between Glycated Haemoglobin Level, Cardiac Function, and Prognosis in Patients with Diabetes Mellitus Combined with Myocardial Infarction. DISEASE MARKERS 2022; 2022:2191294. [PMID: 36193498 PMCID: PMC9525741 DOI: 10.1155/2022/2191294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 11/24/2022]
Abstract
Objective This study was to investigate the correlation between glycated haemoglobin (HbA1c) level, cardiac function, and prognosis in patients with diabetes mellitus combined with myocardial infarction. Methods Ninety-three patients with type 2 diabetes mellitus combined with acute myocardial infarction who were hospitalized and treated in our hospital from January 2021 to June 2021 were recruited for prospective analysis and equally divided into group A (HbA1c < 6.5%), group B (6.5% ≤ HbA1c ≤ 8.5%), and group C (HbA1c > 8.5%) using the random number table method, with 31 patients in each group. General data of patients were collected on admission and blood glucose and cardiac function indexes were measured; the incidence of myocardial infarction and death during the follow-up period was recorded at 6 months after discharge. Results There was a significant difference in blood glucose (FBG) and HbA1c levels at fasting between the three groups (P < 0.05). There were statistically significant differences in plasma levels of N-terminal probrain natriuretic peptide (NT-proBNP) and uric acid (UA), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic volume (LVESV), left ventricular ejection fraction (LVEF), and cardiac function classification of the New York Heart Association (NYHA) among the three groups (P < 0.05). By statistical analysis, the HbA1c level was positively correlated with FBG, NT-proBNP, UA, LVEDD, LVESD, and NYHA grades but negatively correlated with LVEF (P < 0.05). The incidence rate of myocardial infarction and mortality was significantly higher in group C than in groups A and B (P < 0.05). Conclusion HbA1c level in patients with diabetes mellitus combined with myocardial infarction is closely related to the degree of cardiac function damage. Glycated haemoglobin levels are associated with the development of cardiac insufficiency in patients with acute myocardial infarction; glycated haemoglobin is also an independent predictor of major adverse cardiovascular events. Reasonable and effective blood glucose control is of great significance to the prognosis of patients.
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Luo C, Chen F, Liu L, Ge Z, Feng C, Chen Y. Impact of diabetes on outcomes of cardiogenic shock: A systematic review and meta-analysis. Diab Vasc Dis Res 2022; 19:14791641221132242. [PMID: 36250870 PMCID: PMC9580099 DOI: 10.1177/14791641221132242] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
To provide synthesized evidence on the association of diabetes with clinical outcomes of patients with acute myocardial infarction (AMI) and associated cardiogenic shock (CS). We analyzed observational studies on patients with AMI and CS, identified through a systematic search using PubMed and Scopus databases. The main outcome was mortality and other outcomes of interest were risk of major bleeding, re-infarction, cerebrovascular adverse events, and need for revascularization. We conducted the meta-analysis with data from 15 studies. Compared to patients without diabetes, those with diabetes had an increased risk of in-hospital mortality (OR, 1.34; 95% CI, 1.17-1.54) and cerebrovascular complications (OR, 1.28; 95% CI, 1.11-1.48). We found similar risk of major bleeding (OR, 0.68; 95% CI, 0.43-1.09), re-infarction (OR, 0.98; 95% CI, 0.48-1.98) and need for re-vascularization (OR, 0.96; 95% CI, 0.75-1.22) as well as hospital stay lengths (in days) (WMD 0.00; 95% CI, -0.27-0.28; n = 4; I2 = 99.7%) in the two groups of patients. Patients with diabetes, acute MI and associated cardiogenic shock have increased risks of mortality and adverse cerebrovascular events than those without diabetes.
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Affiliation(s)
- Chao Luo
- Department of General Practice, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, China
| | - Feng Chen
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, China
| | - Lingpei Liu
- Department of General Practice, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, China
| | - Zuanmin Ge
- Department of General Practice, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, China
| | - Chengzhen Feng
- Department of General Practice, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, China
| | - Yuehua Chen
- Department of General Practice, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, China
- Yuehua Chen, Department of General Practice, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, 365 Renming East Road, Jinhua, Zhejiang 321000, China.
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Krychtiuk KA, Vrints C, Wojta J, Huber K, Speidl WS. Basic mechanisms in cardiogenic shock: part 2 - biomarkers and treatment options. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:366-374. [PMID: 35218355 DOI: 10.1093/ehjacc/zuac022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/02/2022] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
Cardiogenic shock mortality rates remain high despite significant advances in cardiovascular medicine and the widespread uptake of mechanical circulatory support systems. Except for early invasive angiography and percutaneous coronary intervention of the infarct-related artery, all other widely used therapeutic measures are based on low-quality evidence. The grim prognosis and lack of high-quality data warrant further action. Within Part 2 of this two-part educational review on basic mechanisms in cardiogenic shock, we aimed to highlight the current status of translating our understanding of the pathophysiology of cardiogenic shock into clinical practice. We summarize the current status of biomarker research in risk stratification and therapy guidance. In addition, we summarized the current status of translating the findings from bench-, bedside, and biomarker studies into treatment options. Several large randomized controlled trials (RCTs) are underway, providing a huge opportunity to study contemporary cardiogenic shock patients. Finally, we call for translational, homogenous, biomarker-based, international RCTs testing novel treatment approaches to improve the outcome of our patients.
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Affiliation(s)
- Konstantin A Krychtiuk
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- Duke Clinical Research Institute, 300 W Morgan Street, 27701 Durham, NC, USA
| | - Christiaan Vrints
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Prinsstraat 13, 2000 Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Johann Wojta
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria
- Core Facilities, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Kurt Huber
- Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria
- 3rd Department of Internal Medicine, Cardiology and Intensive Care Unit, Wilhelminenhospital, Montleartstraße 37, 1160 Vienna, Austria
- Medical School, Sigmund Freud University, Freudplatz 1, 1020 Vienna, Austria
| | - Walter S Speidl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Lassus J, Tarvasmäki T, Tolppanen H. Biomarkers in cardiogenic shock. Adv Clin Chem 2022; 109:31-73. [DOI: 10.1016/bs.acc.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Koracevic G, Djordjevic M. Basic types of the first-day glycemia in acute myocardial infarction: Prognostic, diagnostic, threshold and target glycemia. Prim Care Diabetes 2021; 15:614-618. [PMID: 33648853 DOI: 10.1016/j.pcd.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/04/2021] [Accepted: 02/13/2021] [Indexed: 01/08/2023]
Abstract
We described the importance of stress hyperglycemia (SH) in critical illnesses and their evaluation in the emergency department (ED) and coronary care unit (CCU). Hyperglycemia is found in over half of the patients with suspected acute myocardial infarction (AMI). SH can be used for several purposes in AMI. Receiver operating characteristic curves are needed to find optimal cut-offs to divide blood glucose levels associated with good from bad prognosis in AMI. There is a need for a consensus for pragmatic classification of first day glycemia in order to be useful in a busy ED and CCU.
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Affiliation(s)
- Goran Koracevic
- Clinic for cardiovascular diseases, Clinical Center Nis, Serbia; Medical Faculty, University of Nis, Serbia.
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Shi F, Shen L, Yue J, Ma J, Gu Z, Li H, Lin H. Intervention by clinical pharmacists can improve blood glucose fluctuation in patients with diabetes and acute myocardial infarction: A propensity score-matched analysis. Pharmacol Res Perspect 2021; 9:e00725. [PMID: 33641233 PMCID: PMC7914773 DOI: 10.1002/prp2.725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/12/2021] [Indexed: 01/04/2023] Open
Abstract
Acute phase hyperglycemia and exaggerated glucose fluctuation may be associated with poor outcomes in diabetic patients after acute myocardial infarction (AMI). This study aimed to determine whether intervention by clinical pharmacists can mitigate blood glucose and glucose fluctuations in these fragile patients. This retrospective study enrolled patients with diabetes and AMI, from 1 January 2019 to 30 June 2020 in our institution. Blood glucose and glucose fluctuations were calculated before and after the pharmacist's intervention and between patients who underwent intervention and those who did not. Propensity score matching (PSM) was used to reduce the impact of patient characteristics on the results. A total of 170 patients were included in our primary analysis, including 29 patients who received the pharmacist intervention and 141 patients who did not. After the pharmacist's intervention, blood glucose (fasting blood glucose-FBG, from 11.9 to 9.8; postprandial blood glucose-PBG, from 15.3 to 13.2; mean blood glucose-BG, 14.5 to 12.3 mmol/L; p < .001), and glucose fluctuations (standard deviation of blood glucose-SDBG, from 3.8 to 3.0, mmol/L, p = .005) were significantly improved. Before PSM, no clear effects were found in intervention versus nonintervention patients, in terms of blood glucose and glucose fluctuation indicators, except for FBG (9.3 vs. 8.0. mmol/L, p = .005). Further analysis indicated a high incidence of FBG <7.8 mmol/L in nonintervention versus intervention patients (51.5% vs. 27.6%, p = .003). After PSM, a significant reduction in blood glucose fluctuation (SDBG, 3.0 vs. 4.1, p = .031; PBGE, 2.1 vs. 4.1, p = .017; LAGE, 4.7 vs. 7.2, mmol/L, p = .004), and PBG (11.1 vs. 13.0, mmol/L, p = .048) was observed in the intervention group than in the nonintervention group. The clinical pharmacist intervention contributed to improved outcomes, specifically, in reducing blood glucose fluctuations and potential hypoglycemia risk.
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Affiliation(s)
- Fang‐Hong Shi
- Department of PharmacyRenji Hospital, School of Medicine, Shanghai Jiaotong UniversityShanghaiChina
| | - Long Shen
- Department of CardiologyRenji Hospital, School of Medicine, Shanghai Jiaotong UniversityShanghaiChina
| | - Jiang Yue
- Department of EndocrinologyRenji Hospital, School of Medicine, Shanghai Jiaotong UniversityShanghaiChina
| | - Jing Ma
- Department of EndocrinologyRenji Hospital, School of Medicine, Shanghai Jiaotong UniversityShanghaiChina
| | - Zhi‐Chun Gu
- Department of PharmacyRenji Hospital, School of Medicine, Shanghai Jiaotong UniversityShanghaiChina
| | - Hao Li
- Department of Pharmacy, Shanghai Children's Medical CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Hou‐Wen Lin
- Department of PharmacyRenji Hospital, School of Medicine, Shanghai Jiaotong UniversityShanghaiChina
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