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Demir FA, Ersoy İ, Yılmaz AŞ, Taylan G, Kaya EE, Aydın E, Karakayalı M, Öğütveren MM, Acar AT, Hidayet Ş. Serum glucose-potassium ratio predicts inhospital mortality in patients admitted to coronary care unit. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20240508. [PMID: 39383392 PMCID: PMC11460640 DOI: 10.1590/1806-9282.20240508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/01/2024] [Indexed: 10/11/2024]
Abstract
OBJECTIVE The aim of our study was to determine the role of serum glucose-potassium ratio in predicting inhospital mortality in coronary care unit patients. METHODS This study used data from the MORtality in CORonary Care Units in Turkey study, a national, observational, multicenter study that included all patients admitted to coronary care units between September 1, 2022, and September 30, 2022. Statistical analyses assessed the independent predictors of mortality. Two models were created. Model 1 included age, history of heart failure, chronic kidney disease, hypertension, diabetes mellitus, and coronary artery disease. Model 2 included glucose-potassium ratio in addition to these variables. Multivariate regression and receiver operating characteristic analysis were performed to compare Model 1 and Model 2 to identify if the glucose-potassium ratio is an independent predictor of inhospital mortality. RESULTS In a study of 3,157 patients, the mortality rate was 4.3% (n=137). Age (p=0.002), female gender (p=0.004), mean blood pressure (p<0.001), serum creatinine (p<0.001), C-reactive protein (p=0.002), white blood cell (p=0.002), and glucose-potassium ratio (p<0.001) were identified as independent predictors of mortality through multivariate regression analysis. The receiver operating characteristic analysis indicated that Model 2 had a statistically higher area under the curve than Model 1 (area under the curve 0.842 vs area under the curve 0.835; p<0.001). A statistically significant correlation was found between the inhospital mortality and glucose-potassium ratio (OR 1.015, 95%CI 1.006-1.024, p<0.001). CONCLUSION Our study showed that the glucose-potassium ratio may be a significant predictor of inhospital mortality in coronary care unit patients.
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Affiliation(s)
- Fulya Avcı Demir
- Istinye University, Department of Cardiology – İstanbul, Turkey
- Medical Park Hospital, Department of Cardiology – Antalya, Turkey
| | - İbrahim Ersoy
- Kepez State Hospital, Department of Cardiology – Antalya, Turkey
| | - Ahmet Şeyda Yılmaz
- Recep Tayyip Erdogan University, Faculty of Medicine, Department of Cardiology – Rize, Turkey
| | - Gökay Taylan
- Trakya University, Department of Cardiology – Tekirdağ, Turkey
| | - Emin Erdem Kaya
- Ersin Arslan Training and Research Hospital, Department of Cardiology – Gaziantep, Turkey
| | - Ertan Aydın
- Giresun University, Department of Cardiology – Giresun, Turkey
| | - Muammer Karakayalı
- Kafkas University, Training and Research Hospital, Department of Cardiology – Kars, Turkey
| | | | | | - Şıho Hidayet
- Inönü University, Faculty of Medicine, Department of Cardiology – Malatya, Turkey
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Alawaji R, Musslem M, Alshalahi E, Alanzan A, Sufyani A, Alhati M, Almutairi A, Alqaffas M, Alattas B, Alselmi A. A systematic review and meta-analysis of the effect of hyperglycemia on admission for acute myocardial infarction in diabetic and non-diabetic patients. Diabetol Metab Syndr 2024; 16:224. [PMID: 39267155 PMCID: PMC11391676 DOI: 10.1186/s13098-024-01459-w] [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: 06/11/2024] [Accepted: 08/29/2024] [Indexed: 09/14/2024] Open
Abstract
INTRODUCTION Regarding a potential relationship between diabetes and the prognostic significance of hyperglycemia in patients presenting with acute myocardial infarction (AMI), there is still debate. Therefore, we aimed in this study to demonstrate the effect of hyperglycemia on different outcomes in AMI patients, whether they are diabetic or not. METHODS We searched PubMed, Web of Science, and Scopus using the following search strategy: "Diabetes" or "Diabetic" AND "Acute myocardial infarction" OR "AMI" AND "hyperglycemia" OR "glucose level" to find eligible articles that needed to go through the screening process for inclusion in our study. We conducted a meta-analysis of 19 included studies from Japan, Germany, China, the United Kingdom, and others using Review Manager version 5.4 software, pooling the mean difference in continuous variables, the number and total of dichotomous variables to measure the odds ratio (OR), and the generic inverse variance of OR or hazard ratio (HR) as reported in the included studies. RESULTS The mean age of the participants ranged from 56.3 to 72.3 years old. The difference in blood glucose levels between diabetes and non-diabetes patients was found to be statistically significant, with an SMD of 1.39 (95%CI: 1.12, 1.66, p < 0.00001). In diabetic patients, hyperglycemia was statistically significantly associated with mortality, with a HR of 1.92 (95% CI: 1.45, 2.55, p < 0.00001) and an OR of 1.76 (95% CI: 1.15, 2.7, p = 0.01). In non-diabetic patients admitted with AMI, hyperglycemia was statistically significantly associated with mortality, with a HR of 1.56 (95% CI: 1.31, 1.86, p < 0.00001) and an OR of 2.89 (95% CI: 2.47, 3.39, p < 0.00001). AMI patients who were diabetic were statistically more likely to have a major adverse cardiovascular event (MACE) (HR = 1.9; 95% CI: 1.19-3.03; p = 0.007). AMI patients who were not diabetic were also statistically more likely to have a MACE (HR = 1.6; 95% CI: 1.15-2.23, p = 0.006). CONCLUSION Hyperglycemia in AMI patients is a predictor of worse outcomes, including MACE and mortality, regardless of whether these patients are diabetic or not. In these patients, some factors act as predictors of mortality, including older age, higher glucose levels on admission, and a high Killip class.
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Affiliation(s)
- Reem Alawaji
- Clinical Sciences Department, MBBS program, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia.
| | | | | | | | | | - Maram Alhati
- Sulaiman Alrajhi University, Al Bukayriyah, Saudi Arabia
| | | | | | - Batool Alattas
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Adhari Alselmi
- Clinical Sciences Department, MBBS program, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
- Dr.Sulaiman Fakeeh Medical Center, Jeddah, Saudi Arabia
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Hosseini K, Behnoush AH, Khalaji A, Etemadi A, Soleimani H, Pasebani Y, Jenab Y, Masoudkabir F, Tajdini M, Mehrani M, Nanna MG. Machine learning prediction of one-year mortality after percutaneous coronary intervention in acute coronary syndrome patients. Int J Cardiol 2024; 409:132191. [PMID: 38777044 DOI: 10.1016/j.ijcard.2024.132191] [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: 03/10/2024] [Revised: 04/01/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Machine learning (ML) models have the potential to accurately predict outcomes and offer novel insights into inter-variable correlations. In this study, we aimed to design ML models for the prediction of 1-year mortality after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome. METHODS This study was performed on 13,682 patients at Tehran Heart Center from 2015 to 2021. Patients were split into 70:30 for testing and training. Four ML models were designed: a traditional Logistic Regression (LR) model, Random Forest (RF), Extreme Gradient Boosting (XGBoost), and Ada Boost models. The importance of features was calculated using the RF feature selector and SHAP based on the XGBoost model. The Area Under the Receiver Operating Characteristic Curve (AUC-ROC) for the prediction on the testing dataset was the main measure of the model's performance. RESULTS From a total of 9,073 patients with >1-year follow-up, 340 participants died. Higher age and higher rates of comorbidities were observed in these patients. Body mass index and lipid profile demonstrated a U-shaped correlation with the outcome. Among the models, RF had the best discrimination (AUC 0.866), while the highest sensitivity (80.9%) and specificity (88.3%) were for LR and XGBoost models, respectively. All models had AUCs of >0.8. CONCLUSION ML models can predict 1-year mortality after PCI with high performance. A classic LR statistical approach showed comparable results with other ML models. The individual-level assessment of inter-variable correlations provided new insights into the non-linear contribution of risk factors to post-PCI mortality.
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Affiliation(s)
- Kaveh Hosseini
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Behnoush
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Amirmohammad Khalaji
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Etemadi
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Soleimani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yeganeh Pasebani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yaser Jenab
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Masoudkabir
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masih Tajdini
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mehrani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
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Pandey RK, Lwin BB, Vashishta A, Nishat S, Mueka IN, Hassan MU, Nwosu M. Acute Hyperglycemia and Its Impact on Mortality of Acute Coronary Syndrome Patients: A Systematic Review. Cureus 2024; 16:e66365. [PMID: 39247028 PMCID: PMC11378453 DOI: 10.7759/cureus.66365] [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] [Received: 06/19/2024] [Accepted: 08/06/2024] [Indexed: 09/10/2024] Open
Abstract
Acute hyperglycemia or stress hyperglycemia is a frequent finding in patients with acute coronary syndrome (ACS). Several studies have demonstrated the association between acute hyperglycemia with short- and long-term mortality in ACS patients. But the evidence is not concrete. We gathered 1056 articles from three databases, i.e., PubMed, Google Scholar, and Science Direct using different search strategies and filters. We then removed duplicates and 919 articles were screened with title abstract and full text. After a full-text screening of 169 articles, we removed 116 articles. We then applied eligibility criteria and did a quality assessment of articles and finally, we included 21 articles in our study. The 21 articles spanned years 2014 to 2024. Of them, 16 articles were observational studies, two were systematic reviews and meta-analyses, and three were review articles. Six articles used stress hyperglycemia ratio (SHR) alone, seven articles used admission blood glucose (ABG) alone, two used fasting plasma glucose (FPG) alone and one used SHR, ABG, and FPG together as a parameter to measure acute hyperglycemia. Short-term poor outcomes (in-hospital, <30 days) were studied in 12 studies, and long-term poor outcomes (>30 days-1 year, >1 year) were studied in six studies. A positive correlation between acute hyperglycemia and short- and long-term mortality was found in our 21 included studies. The three parameters which are used to quantify acute or stress hyperglycemia in our study, i.e., SHR, ABG, and FPG predict both short- and long-term mortality in ACS patients. Further study is needed to determine the accurate cutoff level of hyperglycemia to be called acute hyperglycemia in diabetics. We tried to review the recent literature on this topic to deepen our understanding of this topic and to provide a base for future research.
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Affiliation(s)
- Ravi K Pandey
- Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Bo B Lwin
- Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Apoorva Vashishta
- Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Samreen Nishat
- Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Isaac N Mueka
- Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Maria U Hassan
- Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Marcellina Nwosu
- Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Shen N, Liu J, Wang Y, Qiu Y, Li D, Wang Q, Chai L, Chen Y, Hu H, Li M. The global burden of ischemic heart disease attributed to high fasting plasma glucose: Data from 1990 to 2019. Heliyon 2024; 10:e27065. [PMID: 38495138 PMCID: PMC10943346 DOI: 10.1016/j.heliyon.2024.e27065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 02/16/2024] [Accepted: 02/23/2024] [Indexed: 03/19/2024] Open
Abstract
Background Ischemic heart disease (IHD) is the leading cause of death worldwide. High fasting plasma glucose (FPG) is an increasing risk factor for IHD. We aimed to explore the long-term trends of high FPG-attributed IHD mortality during 1990-2019. Methods Data were obtained from the Global Burden of Disease Study 2019 database. Deaths, disability-adjusted life-years (DALYs), the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) of IHD attributable to high FPG were estimated by sex, socio-demographic index (SDI), regions and age. Estimated annual percentage changes (EAPCs) were calculated to assess the trends of ASMR and ASDR of IHD attributable to high FPG. Results IHD attributable to high FPG deaths increased from 1.04 million (0.62-1.63) in 1990 to 2.35 million (1.4-3.7) in 2019, and the corresponding DALYs rose from 19.82 million (12.68-29.4) to 43.3 million (27.8-64.2). In 2019, ASMR and ASDR of IHD burden attributable to high FPG were 30.45 (17.09-49.03) and 534.8 (340.7-792.2), respectively. The highest ASMR and ASDR of IHD attributable to high FPG occurred in low-middle SDI quintiles, with 39.28 (22.40-62.76) and 742.3 (461.5-1117.5), respectively, followed by low SDI quintiles and middle SDI quintiles. Males had higher ASMR and ASDR compared to females across the past 30 years. In addition, ASRs of DALYs and deaths were highest in those over 95 years old. Conclusion High FPG-attributed IHD mortality and DALYs have increased dramatically and globally, particularly in low, low-middle SDI quintiles and among the elderly. High FPG remains a great concern on the global burden of IHD and effective prevention and interventions are urgently needed to curb the ranking IHD burden, especially in lower SDI regions.
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Affiliation(s)
- Nirui Shen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Jin Liu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Yan Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Yuanjie Qiu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Danyang Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Qingting Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Limin Chai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Yuqian Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Huizhong Hu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Manxiang Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
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Li K, Yang X, Li Y, Xu G, Ma Y. Relationship between stress hyperglycaemic ratio and incidence of in-hospital cardiac arrest in patients with acute coronary syndrome: a retrospective cohort study. Cardiovasc Diabetol 2024; 23:59. [PMID: 38336786 PMCID: PMC10858560 DOI: 10.1186/s12933-024-02128-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The stress hyperglycaemic ratio (SHR), a new marker that reflects the true hyperglycaemic state of patients with acute coronary syndrome (ACS), is strongly associated with adverse clinical outcomes in these patients. Studies on the relationship between the SHR and in-hospital cardiac arrest (IHCA) incidence are limited. This study elucidated the relationship between the SHR and incidence of IHCA in patients with ACS. METHODS In total, 1,939 patients with ACS who underwent percutaneous coronary intervention (PCI) at the Affiliated Hospital of Zunyi Medical University were included. They were divided into three groups according to the SHR: group T1 (SHR ≤ 0.838, N = 646), group T2 (0.838< SHR ≤ 1.140, N = 646), and group T3 (SHR3 > 1.140, N = 647). The primary endpoint was IHCA incidence. RESULTS The overall IHCA incidence was 4.1% (N = 80). After adjusting for covariates, SHR was significantly associated with IHCA incidence in patients with ACS who underwent PCI (odds ratio [OR] = 2.6800; 95% confidence interval [CI] = 1.6200-4.4300; p<0.001), and compared with the T1 group, the T3 group had an increased IHCA risk (OR = 2.1800; 95% CI = 1.2100-3.9300; p = 0.0090). In subgroup analyses, after adjusting for covariates, patients with ST-segment elevation myocardial infarction (STEMI) (OR = 3.0700; 95% CI = 1.4100-6.6600; p = 0.0050) and non-STEMI (NSTEMI) (OR = 2.9900; 95% CI = 1.1000-8.1100; p = 0.0310) were at an increased IHCA risk. After adjusting for covariates, IHCA risk was higher in patients with diabetes mellitus (DM) (OR = 2.5900; 95% CI = 1.4200-4.7300; p = 0.0020) and those without DM (non-DM) (OR = 3.3000; 95% CI = 1.2700-8.5800; p = 0.0140); patients with DM in the T3 group had an increased IHCA risk compared with those in the T1 group (OR = 2.4200; 95% CI = 1.0800-5.4300; p = 0.0320). The restriction cubic spline (RCS) analyses revealed a dose-response relationship between IHCA incidence and SHR, with an increased IHCA risk when SHR was higher than 1.773. Adding SHR to the baseline risk model improved the predictive value of IHCA in patients with ACS treated with PCI (net reclassification improvement [NRI]: 0.0734 [0.0058-0.1409], p = 0.0332; integrated discrimination improvement [IDI]: 0.0218 [0.0063-0.0374], p = 0.0060). CONCLUSIONS In patients with ACS treated with PCI, the SHR was significantly associated with the incidence of IHCA. The SHR may be a useful predictor of the incidence of IHCA in patients with ACS. The addition of the SHR to the baseline risk model had an incremental effect on the predictive value of IHCA in patients with ACS treated with PCI.
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Affiliation(s)
- Kui Li
- Department of Cardiovascular Medicine, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Zunyi, 563099, Guizhou, China
| | - Xueyuan Yang
- Department of Cardiovascular Medicine, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Zunyi, 563099, Guizhou, China
| | - Yunhang Li
- Department of Cardiovascular Medicine, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Zunyi, 563099, Guizhou, China
| | - Guanxue Xu
- Department of Cardiovascular Medicine, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Zunyi, 563099, Guizhou, China.
| | - Yi Ma
- Department of Cardiovascular Medicine, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Zunyi, 563099, Guizhou, China.
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Zhao C, Liu T, Wei H, Li J. Serum oxidative stress factors predict myocardial ischemia reperfusion injury after percutaneous coronary intervention in patients with acute myocardial infarction and type 2 diabetes mellitus. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2023; 19:333-342. [PMID: 38187486 PMCID: PMC10767562 DOI: 10.5114/aic.2023.133475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/14/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Serum oxidative stress factors may be considered to be essential parameters for indicating cell oxidative damage. Aim We designed this study to investigate the clinical diagnostic value of serum oxidative stress factors (superoxide dismutase (SOD), malondialdehyde (MDA), and myeloperoxidase (MPO)) combined with ischemia-modified albumin (IMA) and heat shock protein 70 (HSP70) for myocardial ischemia-reperfusion injury (MIRI) after percutaneous coronary intervention (PCI) in elderly patients with acute myocardial infarction (AMI) and type 2 diabetes mellitus (T2DM). Material and methods From November 2020 to August 2021, 94 patients with AMI + T2DM and 86 patients with AMI were enrolled in the study; they were sub-grouped into the MIRI and non-MIRI groups following the occurrence of MIRI within 48 h after PCI. SOD, MDA, MPO, IMA, and HSP70 levels were determined. The clinical values of the combined serum oxidative stress factors, IMA, and HSP70 levels to predict MIRI events were analyzed. Results There was a higher probability of MIRI events in the AMI + T2DM group than the AMI group (p < 0.05). The ROC curve for the combined prediction of SOD, MDA, MPO, IMA, and HSP70 for the occurrence of MIRI events was higher in both the AMI and the AMI + T2DM groups than for predictive factors alone (all p < 0.05). Conclusions Combined prediction of SOD, MDA, MPO, IMA, and HSP70 has the highest diagnostic value for predicting MIRI events after PCI in AMI patients, especially in patients with AMI combined with T2DM.
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Affiliation(s)
- Chunyu Zhao
- Department of General Practice, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tianze Liu
- Clinical Medical College of Jiamusi University, Jiamusi, Heilongjiang, China
| | - Hong Wei
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jianing Li
- Department of General Practice, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Kononova Y, Abramyan L, Derevitskii I, Babenko A. Predictors of Carbohydrate Metabolism Disorders and Lethal Outcome in Patients after Myocardial Infarction: A Place of Glucose Level. J Pers Med 2023; 13:997. [PMID: 37373986 PMCID: PMC10305089 DOI: 10.3390/jpm13060997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/29/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND AND AIM The aim of this study was to reveal statistical patterns in patients with acute myocardial infarction (AMI) that cause the development of carbohydrate metabolism disorders (CMD) (type 2 diabetes mellitus and prediabetes) and death within 5 years after AMI. METHODS 1079 patients who were treated with AMI in the Almazov National Medical Research Center were retrospectively selected for the study. For each patient, all data from electronic medical records were downloaded. Statistical patterns that determine the development of CMDs and death within 5 years after AMI were identified. To create and train the models used in this study, the classic methods of Data Mining, Data Exploratory Analysis, and Machine Learning were used. RESULTS The main predictors of mortality within 5 years after AMI were advanced age, low relative level of lymphocytes, circumflex artery lesion, and glucose level. Main predictors of CMDs were low basophils, high neutrophils, high platelet distribution width, and high blood glucose level. High values of age and glucose together were relatively independent predictors. With glucose level >11 mmol/L and age >70 years, the 5-year risk of death is about 40% and it rises with increasing glucose levels. CONCLUSION The obtained results make it possible to predict the development of CMDs and death based on simple parameters that are easily available in clinical practice. Glucose level measured on the 1st day of AMI was among the most important predictors of CMDs and death.
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Affiliation(s)
- Yulia Kononova
- World-Class Research Centre for Personalized Medicine, Almazov National Medical Research Centre, 197341 St. Petersburg, Russia
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Shen H, Wang S, Zhang C, Gao W, Cui X, Zhang Q, Lang Y, Ning M, Li T. Association of hyperglycemia ratio and ventricular arrhythmia in critically ill patients admitted to the intensive care unit. BMC Cardiovasc Disord 2023; 23:215. [PMID: 37118670 PMCID: PMC10148444 DOI: 10.1186/s12872-023-03208-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/27/2023] [Indexed: 04/30/2023] Open
Abstract
INTRODUCTION The relationship between relative hyperglycemia and ventricular arrhythmia (VA) in critically ill patients admitted to intensive care units (ICU) remains unclear. This study aims to investigate the association between stress hyperglycemia ratio (SHR) and VA in this population. METHODS This retrospective and observational study analyzed data from 4324 critically ill patients admitted to the ICU, obtained from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The SHR was calculated as the highest blood glucose level during the first 24 h of ICU admission divided by the admission blood glucose level. Based on the optimal cut-off values under the receiver operating characteristic curve, patients were stratified into high SHR (≥ 1.31) and low SHR (< 1.31) group. To investigate the impact of diabetes mellitus (DM) on the outcome, patients were stratified as low SHR/DM; low SHR/non-DM; high SHR/DM, and high SHR/non-DM. Restricted cubic spline (RCS) and logistic regression analysis were performed to analyze the relationship between SHR and VA. RESULTS A total of 4,324 critically ill patients were included in this retrospective and observational study. The incidence of VA was higher in the high SHR group. Multiple-adjusted RCS revealed a "J-shaped" correlation between SHR and VA morbidity. The logistic regression model demonstrated that high SHR was associated with VA. The high SHR/non-DM group had a higher risk of VA than other groups stratified based on SHR and DM. Subgroup analysis showed that high SHR was associated with an increased risk of VA in patients with coronary artery disease. CONCLUSION High SHR is an independent risk factor and has potential as a biomarker of higher VT/VF risk in ICU-admitted patients.
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Affiliation(s)
- Hechen Shen
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China
- Department of Heart Center, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Tianjin ECMO Treatment and Training Base, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
| | - Song Wang
- Department of Heart Center, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Tianjin ECMO Treatment and Training Base, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
| | - Chong Zhang
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China
- Department of Heart Center, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Tianjin ECMO Treatment and Training Base, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
| | - Wenqing Gao
- Department of Heart Center, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Tianjin ECMO Treatment and Training Base, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
- Nankai University Affiliated Third Center Hospital, Nankai University, Tianjin, China
| | - Xiaoqiong Cui
- Department of Heart Center, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Tianjin ECMO Treatment and Training Base, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
- Nankai University Affiliated Third Center Hospital, Nankai University, Tianjin, China
| | - Qiang Zhang
- Department of Heart Center, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Tianjin ECMO Treatment and Training Base, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
- Nankai University Affiliated Third Center Hospital, Nankai University, Tianjin, China
| | - Yuheng Lang
- Department of Heart Center, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Tianjin ECMO Treatment and Training Base, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
- Nankai University Affiliated Third Center Hospital, Nankai University, Tianjin, China
| | - Meng Ning
- Department of Heart Center, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Tianjin ECMO Treatment and Training Base, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
- Nankai University Affiliated Third Center Hospital, Nankai University, Tianjin, China
| | - Tong Li
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China.
- Department of Heart Center, The Third Central Hospital of Tianjin, Tianjin, China.
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China.
- Tianjin ECMO Treatment and Training Base, Tianjin, China.
- Artificial Cell Engineering Technology Research Center, Tianjin, China.
- School of Medicine, Nankai University, Tianjin, China.
- Nankai University Affiliated Third Center Hospital, Nankai University, Tianjin, China.
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10
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Chen Q, Su H, Yu X, Chen Y, Ding X, Xiong B, Wang C, Xia L, Ye T, Lan K, Hou J, Xiong S, Cai L. The stress hyperglycemia ratio improves the predictive ability of the GRACE score for in-hospital mortality in patients with acute myocardial infarction. Hellenic J Cardiol 2022; 70:36-45. [PMID: 36586422 DOI: 10.1016/j.hjc.2022.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The Global Registry of Acute Coronary Events (GRACE) score is a powerful tool used to predict in-hospital mortality after acute myocardial infarction (AMI) and does not include a glycometabolism-related index. We investigated whether the addition of the stress hyperglycemia ratio (SHR) provides incremental prognostic value in addition to the GRACE score. METHODS A retrospective cohort of 613 AMI patients was enrolled in the present analyses. The patients were stratified according to the primary endpoint (in-hospital mortality) and the tertiles of the SHR. RESULTS During hospitalization, 40 patients reached the primary endpoint, which was more frequently observed in patients with a higher SHR. The SHR, but not admission blood glucose (ABG), adjusted for the GRACE score independently predicted in-hospital mortality [odds ratio 2.5861; 95% confidence interval (CI), 1.3910-4.8080; P = 0.0027]. The adjustment of the GRACE score by the SHR improved the predictive ability for in-hospital death (an increase in the C-statistic value from 0.787 to 0.814; net reclassification improvement, 0.6717, 95% CI 0.3665-0.977, P < 0.01; integrated discrimination improvement, 0.028, 95% CI 0.0066-0.0493, P = 0.01028). The likelihood ratio test showed that the SHR significantly improved the prognostic models, including the GRACE score. Adding the SHR to the GRACE score presented a larger net benefit across the range of in-hospital mortality risk than the GRACE score alone. CONCLUSION The SHR, but not the ABG, is an independent predictor of in-hospital mortality after AMI even after adjusting for the GRACE score. The SHR improves the predictability and clinical usefulness of prognostic models containing the GRACE score.
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Affiliation(s)
- Qiang Chen
- From Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, China
| | - Hong Su
- From Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, China
| | - Xiuqiong Yu
- From Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, China
| | - Yingzhong Chen
- From Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, China
| | - Xunshi Ding
- From Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, China
| | - Bo Xiong
- From Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, China
| | - Chunbin Wang
- From Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, China
| | - Long Xia
- From Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, China
| | - Tao Ye
- From Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, China
| | - Kai Lan
- From Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, China
| | - Jun Hou
- From Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, China
| | - Shiqiang Xiong
- From Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, China.
| | - Lin Cai
- From Department of Cardiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu Cardiovascular Disease Research Institute, Chengdu 610014, Sichuan, China.
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11
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Sun Z, Gao X. SRPX2 attenuated oxygen–glucose deprivation and reperfusion-induced injury in cardiomyocytes via alleviating endoplasmic reticulum stress-induced apoptosis through targeting PI3K/Akt/mTOR axis. Open Life Sci 2022; 17:1497-1504. [DOI: 10.1515/biol-2022-0513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/06/2022] [Accepted: 09/18/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Myocardial infraction (MI) is the leading cause of high morbidity and mortality worldwide. It was still urgently needed to find new and effective drugs for MI treatment by the use of myocardial ischemia/reperfusion (I/R) model. Sushi repeats contain the protein X-Linked 2 (SRPX2), which regulates a variety of important cell functions. However, its possible role in myocardial I/R and the progression of MI is still unclear. In this study, we investigated the role of SRPX2 in myocardial I/R. SRPX2 showed low expression in IR rats and H9C2 cells induced by oxygen–glucose deprivation/reperfusion (OGD/R). SRPX2 could increase OGD/R-induced H9C2 cell survival. In addition, SRPX2 suppressed the apoptosis of OGD/R-induced H9C2 cells. Furthermore, we found that SRPX2 could inhibit ER stress induced by OGD/R in H9C2 cells. Mechanically, we found that SRPX2 suppressed the PI3K/Akt/mTOR pathway, thus attenuating OGD/R -induced injury in H9C2 cells. Therefore, SRPX2 has the potential to serve as a target for MI treatment.
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Affiliation(s)
- Zhiyuan Sun
- Department of Cardiovascular, Tianjin Fifth Central Hospital , Tianjin 300450 , China
| | - Xin Gao
- Department of Cardiology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine , No. 100, Cross Street, Hongshan Road , Nanjing City , Jiangsu Province 210028 , China
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12
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Liu L, Qian J, Yan W, Liu X, Zhao Y, Che L. Relationship between hyperglycaemia at admission and prognosis in patients with acute myocardial infarction: a retrospective cohort study. Postgrad Med J 2022:7148071. [PMID: 37130824 DOI: 10.1136/pmj-2021-141454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 09/05/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND The optimal threshold of hyperglycaemia at admission for identifying high-risk individuals in patients with acute myocardial infarction (AMI) and its impact on clinical prognosis are still unclear. METHODS We retrospectively reviewed 2027 patients with AMI admitted from June 2001 to December 2012 in the 'Medical Information Mart for Intensive Care III' database. The significant cut-off values of admission blood glucose (Glucose_0) for predicting hospital mortality in patients with AMI with and without diabetes were obtained from the receiver operating characteristic (ROC) curve, then patients were assigned to hyperglycaemia and non-hyperglycaemia groups based on corresponding cut-off values. The primary endpoints were the hospital and 1-year mortality. RESULTS Among 2027 patients, death occurred in 311 patients (15.3%). According to the ROC curve, the significant cut-off values of Glucose_0 to predict hospital mortality were 224.5 and 139.5 mg/dL in patients with diabetes and without diabetes, respectively. The crude hospital and 1-year mortality of the hyperglycaemia subgroup were higher than the corresponding non-hyperglycaemia group (p< 0.01). After adjustment, regardless of the state of diabetes, hyperglycaemia at admission was related to significantly increased hospital mortality in patients with AMI. For patients with AMI without diabetes, hyperglycaemia at admission was positively correlated with the increase of 1-year mortality (HR, 1.47; 95% CI 1.18 to 1.82; p=0.001). Nevertheless, this trend disappeared in those with diabetes (HR, 1.35; 95% CI 0.93 to 1.95; p=0.113). CONCLUSION Hyperglycaemia at admission was an independent predictor for mortality during hospitalisation and at 1-year in patients with AMI, especially in patients without diabetes.
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Affiliation(s)
- Linlin Liu
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun Qian
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenwen Yan
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuebo Liu
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ya Zhao
- Department of Cardiology, Kong Jiang Hospital Of Yangpu District, Shanghai, China
| | - Lin Che
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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13
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Schmitz T, Freuer D, Harmel E, Heier M, Peters A, Linseisen J, Meisinger C. Prognostic value of stress hyperglycemia ratio on short- and long-term mortality after acute myocardial infarction. Acta Diabetol 2022; 59:1019-1029. [PMID: 35532812 PMCID: PMC9242951 DOI: 10.1007/s00592-022-01893-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/09/2022] [Indexed: 01/08/2023]
Abstract
AIMS Prior studies demonstrated an association between hospital admission blood glucose and mortality in acute myocardial infarction (AMI). Because stress hyperglycemia ratio (SHR) has been suggested as a more reliable marker of stress hyperglycemia this study investigated to what extent SHR in comparison with admission blood glucose is associated with short- and long-term mortality in diabetic and non-diabetic AMI patients. METHODS The analysis was based on 2,311 AMI patients aged 25-84 years from the population-based Myocardial Infarction Registry Augsburg (median follow-up time 6.5 years [IQR: 4.9-8.1]). The SHR was calculated as admission glucose (mg/dl)/(28.7 × HbA1c (%)-46.7). Using logistic and COX regression analyses the associations between SHR and admission glucose and mortality were investigated. RESULT Higher admission glucose and higher SHR were significantly and nonlinearly associated with higher 28-day mortality in AMI patients with and without diabetes. In patients without diabetes, the AUC for SHR was significantly lower than for admission glucose (SHR: 0.6912 [95%CI 0.6317-0.7496], admission glucose: 0.716 [95%CI 0.6572-0.7736], p-value: 0.0351). In patients with diabetes the AUCs were similar for SHR and admission glucose. Increasing admission glucose and SHR were significantly nonlinearly associated with higher 5-year all-cause mortality in AMI patients with diabetes but not in non-diabetic patients. AUC values indicated a comparable prediction of 5-year mortality for both measures in diabetic and non-diabetic patients. CONCLUSIONS Stress hyperglycemia in AMI patients plays a significant role mainly with regard to short-term prognosis, but barely so for long-term prognosis, underlining the assumption that it is a transient dynamic disorder that occurs to varying degrees during the acute event, thereby affecting prognosis.
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Affiliation(s)
- T Schmitz
- Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
| | - D Freuer
- Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - E Harmel
- Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
| | - M Heier
- KORA Study Centre, University Hospital of Augsburg, Augsburg, Germany
- Institute for Epidemiology, Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - A Peters
- Institute for Epidemiology, Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - J Linseisen
- Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - C Meisinger
- Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
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Lin L, Lin Y, Peng Y, Huang X, Zhang X, Chen L, Li S. Admission Hyperglycemia in Acute Type A Aortic Dissection Predicts for a Prolonged Duration of Mechanical Ventilation. Int Heart J 2022; 63:106-112. [DOI: 10.1536/ihj.21-485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Lingyu Lin
- School of Nursing, Fujian Medical University
| | - Yanjuan Lin
- Department of Nursing, Fujian Medical University Union Hospital
| | - Yanchun Peng
- Department of Cardiac Surgery, Fujian Medical University Union Hospital
| | - Xizhen Huang
- Department of Cardiac Surgery, Fujian Medical University Union Hospital
| | | | - Liangwan Chen
- Department of Cardiac Surgery, Fujian Medical University Union Hospital
| | - Sailan Li
- Department of Cardiac Surgery, Fujian Medical University Union Hospital
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Goldstein DS. Stress and the "extended" autonomic system. Auton Neurosci 2021; 236:102889. [PMID: 34656967 PMCID: PMC10699409 DOI: 10.1016/j.autneu.2021.102889] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/06/2021] [Accepted: 09/28/2021] [Indexed: 12/22/2022]
Abstract
This review updates three key concepts of autonomic neuroscience-stress, the autonomic nervous system (ANS), and homeostasis. Hans Selye popularized stress as a scientific idea. He defined stress variously as a stereotyped response pattern, a state that evokes this pattern, or a stimulus that evokes the state. According to the "homeostat" theory stress is a condition where a comparator senses a discrepancy between sensed afferent input and a response algorithm, the integrated error signal eliciting specific patterns of altered effector outflows. Scientific advances since Langley's definition of the ANS have incited the proposal here of the "extended autonomic system," or EAS, for three reasons. (1) Several neuroendocrine systems are bound inextricably to Langley's ANS. The first to be described, by Cannon in the early 1900s, involves the hormone adrenaline, the main effector chemical of the sympathetic adrenergic system. Other neuroendocrine systems are the hypothalamic-pituitary-adrenocortical system, the arginine vasopressin system, and the renin-angiotensin-aldosterone system. (2) An evolving body of research links the ANS complexly with inflammatory/immune systems, including vagal anti-inflammatory and catecholamine-related inflammasomal components. (3) A hierarchical network of brain centers (the central autonomic network, CAN) regulates ANS outflows. Embedded within the CAN is the central stress system conceptualized by Chrousos and Gold. According to the allostasis concept, homeostatic input-output curves can be altered in an anticipatory, feed-forward manner; and prolonged or inappropriate allostatic adjustments increase wear-and-tear (allostatic load), resulting in chronic, stress-related, multi-system disorders. This review concludes with sections on clinical and therapeutic implications of the updated concepts offered here.
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Affiliation(s)
- David S Goldstein
- Autonomic Medicine Section, Clinical Neurosciences Program, Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA; Autonomic Medicine Section, CNP/DIR/NINDS/NIH, 9000 Rockville Pike MSC-1620, Building 10 Room 8N260, Bethesda, MD 20892-1620, USA..
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Ferreira JA, Baptista RM, Monteiro SR, Gonçalves FM, Monteiro PF, Gonçalves LM. Admission hyperglycemia and all-cause mortality in diabetic and non-diabetic patients with acute myocardial infarction: a tertiary center analysis. Intern Emerg Med 2021; 16:2109-2119. [PMID: 33713285 DOI: 10.1007/s11739-021-02693-0] [Citation(s) in RCA: 18] [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] [Received: 11/10/2020] [Accepted: 03/01/2021] [Indexed: 01/08/2023]
Abstract
Admission hyperglycemia (AH) is associated with worse prognosis in patients with acute myocardial infarction (AMI). Controversy remains whether the impact of AH differs among patients previously diagnosed with diabetes mellitus (DM). We retrospectively evaluated consecutive patients admitted in a coronary care unit with AMI, from 2006 to 2014. Patients were divided into 4 groups: patients without known DM with admission glycemia (AG) ≤ 143 mg/dL (group 1), patients without known DM with AG > 143 mg/dL (group 2), known DM with AG ≤ 213 mg/dL (group 3), and known DM with AG > 213 mg/dL (group 4). Primary outcome was defined as all-cause mortality during follow-up. A total of 2768 patients were included: 1425 in group 1, 426 in group 2, 593 in group 3, and 325 in group 4. After a median follow-up of 5.6 years, 1047 (37.8%) patients reached primary outcome. After multivariate analysis, group 4 was associated with the worst prognosis (HR 3.103, p < 0.001) followed by group 3 (HR 1.639, p = 0.002) and group 2 (HR 1.557, p = 0.039), when compared to group 1. When groups were stratified by type of AMI, patients in group 2 had a worse prognosis than patients in group 3 in the case of non-ST-segment elevation AMI. AH is associated with higher all-cause mortality in patients with AMI, irrespective of previous diabetic status.
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Affiliation(s)
- João André Ferreira
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta, R. Professor Mota Pinto, 3004-561, Coimbra, Portugal.
| | - Rui Miguel Baptista
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta, R. Professor Mota Pinto, 3004-561, Coimbra, Portugal
- Faculty of Medicine, iCBR, University of Coimbra, Coimbra, Portugal
| | - Sílvia Reis Monteiro
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta, R. Professor Mota Pinto, 3004-561, Coimbra, Portugal
| | - Francisco Manuel Gonçalves
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta, R. Professor Mota Pinto, 3004-561, Coimbra, Portugal
| | - Pedro Filipe Monteiro
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta, R. Professor Mota Pinto, 3004-561, Coimbra, Portugal
- Faculty of Medicine, iCBR, University of Coimbra, Coimbra, Portugal
| | - Lino Manuel Gonçalves
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta, R. Professor Mota Pinto, 3004-561, Coimbra, Portugal
- Faculty of Medicine, iCBR, University of Coimbra, Coimbra, Portugal
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Mamadjanov T, Volaklis K, Heier M, Freuer D, Amann U, Peters A, Kuch B, Thilo C, Linseisen J, Meisinger C. Admission glucose level and short-term mortality in older patients with acute myocardial infarction: results from the KORA Myocardial Infarction Registry. BMJ Open 2021; 11:e046641. [PMID: 34083341 PMCID: PMC8183232 DOI: 10.1136/bmjopen-2020-046641] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
STUDY OBJECTIVES To investigate the association between admission blood glucose levels and 28-day mortality as well as in-hospital complications in older patients with incident acute myocardial infarction (AMI) undergoing modern treatment. METHODS From a German population-based regional MI registry, 5530 patients (2016 women), aged 65-84 years, hospitalised with an incident AMI between 1 January 2009 and 31 December 2016 were included in the study. Multivariable logistic regression models were used to assess the associations between admission blood glucose and 28-day mortality as well as in-hospital complications after AMI. Analyses stratified according to age, diabetes and type of infarction (ST-elevation MI (STEMI)/non-STEMI) were conducted. RESULTS The adjusted ORs for the association between admission blood glucose and 28-day mortality in young-old (65-74 years) and old (75-84 years) patients with AMI were 1.40 (95% CI: 1.21 to 1.62) and 1.21 (95% CI: 0.98 to 1.50) per 1 SD increase in admission blood glucose, respectively. Furthermore, higher admission blood glucose was related to case fatality irrespective of the diabetes status and type of infarction only in the under-75 group. For the patients aged 75-84 years, it was only true for those without diabetes and STEMI. Admission blood glucose was also associated with major cardiac complications in both age groups. CONCLUSION Admission blood glucose was significantly associated with 28-day case fatality in patients with AMI aged 65-74 years but not 75-84 years; furthermore, in both age groups there was an increased risk of major complications. It seems that admission glucose may play a rather minor role in terms of case fatality in higher aged patients with AMI.
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Affiliation(s)
- Temur Mamadjanov
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University of Munich, Munchen, Germany
- Chair of Epidemiology, UNIKA-T Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Germany
| | - Konstantinos Volaklis
- Chair of Epidemiology, UNIKA-T Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum Munchen, German Research Center for Health and Environment, Neuherberg, Germany
- KORA Study Centre, University Hospital Augsburg, Augsburg, Germany
| | - Dennis Freuer
- Chair of Epidemiology, UNIKA-T Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Germany
| | - Ute Amann
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum Munchen, German Research Center for Health and Environment, Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum Munchen, German Research Center for Health and Environment, Neuherberg, Germany
| | - B Kuch
- Department of Internal Medicine/Cardiology, Hospital of Nördlingen, Nördlingen, Germany
| | - Christian Thilo
- Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
| | - Jakob Linseisen
- Chair of Epidemiology, UNIKA-T Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Germany
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum Munchen, German Research Center for Health and Environment, Neuherberg, Germany
| | - Christa Meisinger
- Chair of Epidemiology, UNIKA-T Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Germany
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18
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Zhang L, Wang Z, Xu F, Han D, Li S, Yin H, Lyu J. Effects of Stress Hyperglycemia on Short-Term Prognosis of Patients Without Diabetes Mellitus in Coronary Care Unit. Front Cardiovasc Med 2021; 8:683932. [PMID: 34095265 PMCID: PMC8169960 DOI: 10.3389/fcvm.2021.683932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/19/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Diabetes mellitus (DM) has a high morbidity and mortality worldwide, and it is a risk factor for cardiovascular diseases. Non-diabetic stress hyperglycemia is common in severely ill patients, and it could affect prognosis. This study aimed to analyze the influence of different blood glucose levels on prognosis from the perspective of stress hyperglycemia by comparing them with normal blood glucose levels and those of patients with DM. Methods: A retrospective study of 1,401 patients in coronary care unit (CCU) from the critical care database called Medical Information Mart for Intensive Care IV was performed. Patients were assigned to the following groups 1–4 based on their history of DM, random blood glucose, and HbA1c levels: normal blood glucose group, moderate stress hyperglycemia group, severe stress hyperglycemia group and DM group. The main outcome of this study was 30- and 90-day mortality rates. The associations between groups and outcomes were analyzed using Kaplan–Meier survival analysis, Cox proportional hazard regression model and competing risk regression model. Results: A total of 1,401 patients in CCU were enrolled in this study. The Kaplan–Meier survival curve showed that group 1 had a higher survival probability than groups 3 and 4 in terms of 30- and 90-day mortalities. After controlling the potential confounders in Cox regression, groups 3 and 4 had a statistically significant higher risk of both mortalities than group 1, while no difference in mortality risk was found between groups 2 and 1. The hazard ratios [95% confidence interval (CI)] of 30- and 90-day mortality rates for group 3 were 2.77(1.39,5.54) and 2.59(1.31,5.12), respectively, while those for group 4 were 1.92(1.08,3.40) and 1.94(1.11,3.37), respectively. Conclusions: Severe stress hyperglycemia (≥200 mg/dL) in patients without DM in CCU may increase the risk of short-term death, which is greater than the prognostic effect in patients with diabetes. Patients with normal blood glucose levels and moderate stress hyperglycemia (140 mg/dL ≤ RBG <200 mg/dL) had no effect on short-term outcomes in patients with CCU.
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Affiliation(s)
- Luming Zhang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zichen Wang
- Department of Public Health, University of California, Irvine, Irvine, CA, United States
| | - Fengshuo Xu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Didi Han
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Shaojin Li
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Haiyan Yin
- Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
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19
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Liu W, Li Z, Xing S, Xu Y. Effect of Admission Hyperglycemia on Short-Term Prognosis of Patients with Non-ST Elevation Acute Coronary Syndrome without Diabetes Mellitus. J Diabetes Res 2021; 2021:1321289. [PMID: 34912898 PMCID: PMC8668326 DOI: 10.1155/2021/1321289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To evaluate the effect of admission hyperglycemia on the short-term prognosis of patients with non-ST elevation acute coronary syndrome (NSTE-ACS) without diabetes mellitus. METHODS The clinical data of 498 patients with NSTE-ACS admitted to the Department of Cardiology of the First Affiliated Hospital of Henan University of Science and Technology between March 2018 and November 2020 were analyzed. Based on the blood glucose (BG) level at admission, patients were divided into three groups: A (BG < 7.8 mmol/L), B (7.8 mmol/L ≤ BG < 11.1 mmol/L), and C (BG ≥ 11.1 mmol/L). The clinical data of the three groups were compared. RESULTS There was no significant difference between the three groups in terms of age, sex, hypertension, hyperlipidemia, smoking, and history of myocardial infarction (p > 0.05). However, there were significant differences in the incidences of multivessel disease, renal insufficiency, pump failure, and emergency percutaneous coronary intervention, and levels of high-sensitivity C-reactive protein, cardiac troponin T, and creatine kinase isoenzyme MB among the three groups (p < 0.05 for all). The incidences of severe pump failure, malignant arrhythmias, and death were significantly higher in groups B and C compared to group A (p < 0.05). Additionally, the incidences of severe pump failure, malignant arrhythmias, and death were significantly higher in group C compared to group B (p < 0.05). Multivariate logistic regression analysis showed that hyperglycemia, renal insufficiency, Killip grade III/IV, and age were risk factors of in-hospital death. CONCLUSION Hyperglycemia at admission is a risk factor for adverse in-hospital clinical outcomes in patients with NSTE-ACS.
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Affiliation(s)
- Wei Liu
- Department of Cardiology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang 471003, China
| | - Zhijuan Li
- Department of Cardiology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang 471003, China
| | - Shiying Xing
- Department of Cardiology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang 471003, China
| | - Yanwei Xu
- School of Mechatronics Engineering, Henan University of Science and Technology, Luoyang 471003, China
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20
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Koraćević G, Mićić S, Stojanović M, Tomašević M, Kostić T, Koraćević M, Janković I. Single prognostic cut-off value for admission glycemia in acute myocardial infarction has been used although high-risk stems from hyperglycemia as well as from hypoglycemia (a narrative review). Prim Care Diabetes 2020; 14:594-604. [PMID: 32988774 DOI: 10.1016/j.pcd.2020.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/30/2020] [Accepted: 09/10/2020] [Indexed: 01/08/2023]
Abstract
All original articles and meta-analysis use the single cut-off value to distinguish high-risk hyperglycemic from other acute myocardial infarction (AMI) patients. The mortality rate is 3.9 times higher in non-diabetic AMI patients with admission glycemia ≥6.1mmol compared to normoglycemic non-diabetic AMI patients. On the other hand, admission hypoglycemia in AMI is an important predictor of mortality. Because both admission hypo- and hyperglycemia correspond to higher in-hospital mortality, this graph is recognized as "J or U shaped curve". The review suggests two cut-off values for admission glycemia for risk assessment in AMI instead of single one because hypoglycemia as well as hyperglycemia represents a high-risk factor.
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Affiliation(s)
- Goran Koraćević
- Department for Cardiovascular Diseases, Clinical Center Niš, Serbia; Faculty of Medicine, University of Niš, Serbia
| | | | | | - Miloje Tomašević
- Faculty of Medicine, University of Belgrade, Department of Cardiology, Clinical Center Serbia, Belgrade, Serbia
| | - Tomislav Kostić
- Department for Cardiovascular Diseases, Clinical Center Niš, Serbia; Faculty of Medicine, University of Niš, Serbia
| | - Maja Koraćević
- Faculty of Medicine, University of Niš, Serbia; Innovation Center, University of Niš, Serbia
| | - Irena Janković
- Faculty of Medicine, University of Niš, Serbia; Clinic of Plastic and Reconstructive Surgery, Clinical Center Niš, Serbia
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21
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Abstract
The pandemic viral illness COVID-19 is especially life-threatening in the elderly and in those with any of a variety of chronic medical conditions. This essay explores the possibility that the heightened risk may involve activation of the "extended autonomic system" (EAS). Traditionally, the autonomic nervous system has been viewed as consisting of the sympathetic nervous system, the parasympathetic nervous system, and the enteric nervous system. Over the past century, however, neuroendocrine and neuroimmune systems have come to the fore, justifying expansion of the meaning of "autonomic." Additional facets include the sympathetic adrenergic system, for which adrenaline is the key effector; the hypothalamic-pituitary-adrenocortical axis; arginine vasopressin (synonymous with anti-diuretic hormone); the renin-angiotensin-aldosterone system, with angiotensin II and aldosterone the main effectors; and cholinergic anti-inflammatory and sympathetic inflammasomal pathways. A hierarchical brain network-the "central autonomic network"-regulates these systems; embedded within it are components of the Chrousos/Gold "stress system." Acute, coordinated alterations in homeostatic settings (allostasis) can be crucial for surviving stressors such as traumatic hemorrhage, asphyxiation, and sepsis, which throughout human evolution have threatened homeostasis; however, intense or long-term EAS activation may cause harm. While required for appropriate responses in emergencies, EAS activation in the setting of chronically decreased homeostatic efficiencies (dyshomeostasis) may reduce thresholds for induction of destabilizing, lethal vicious cycles. Testable hypotheses derived from these concepts are that biomarkers of EAS activation correlate with clinical and pathophysiologic data and predict outcome in COVID-19 and that treatments targeting specific abnormalities identified in individual patients may be beneficial.
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Affiliation(s)
- David S Goldstein
- Autonomic Medicine Section, Clinical Neurosciences Program, Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 9000 Rockville Pike MSC-1620, Building 10 Room 8N260, Bethesda, MD, 20892-1620, USA.
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