Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Division of Cardiology, Clinical Atherosclerosis Research Lab, University of Washington, Seattle, WA, USA.
Angiology. 2020 Jan;71(1):38-47. doi: 10.1177/0003319719875632. Epub 2019 Sep 25.
This study investigated whether a novel index of stress hyperglycemia might have a better prognostic value compared to admission glycemia alone in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). The acute-to-chronic glycemic ratio was expressed as admission blood glucose (ABG) devided by the estimated average glucose (eAG), and eAG was derived from the glycated hemoglobin (HbA1c). A total of 1300 consecutive patients with STEMI treated with PCI were included. Baseline data and outcomes were analyzed. The study end point was a composite of in-hospital all-cause death, cardiogenic shock, and acute pulmonary edema. Accuracy was defined with area under the curve (AUC) by a receiver-operating characteristic (ROC) curve analysis. After multivariate adjustment, both ABG/eAG and ABG were closely associated with an increased risk of the composite end point in nondiabetic patients. However, only ABG/eAG (odds ratio = 2.45, 95% confidence interval: 1.24-4.82, = .010), instead of ABG, was associated with the outcomes in diabetic patients. Compared to ABG, ABG/eAG had an equivalent predictive value in nondiabetic patients but a superior discriminatory ability in diabetic patients (AUC improved from 0.52-0.63, < .001). Taken together, ABG/eAG provides more significant in-hospital prognostic information than ABG in diabetic patients with STEMI after PCI.
这项研究旨在探讨与入院时血糖相比，急性与慢性血糖比值（以入院时血糖除以平均估计血糖（eAG）表示，而 eAG 则由糖化血红蛋白（HbA1c）推算）是否在接受经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者中具有更好的预后价值。共纳入 1300 例连续接受 PCI 治疗的 STEMI 患者，分析其基线数据和结局。研究终点为院内全因死亡、心源性休克和急性肺水肿的复合终点。准确性通过接收者操作特征（ROC）曲线分析的曲线下面积（AUC）定义。多变量调整后，入院时血糖/ eAG 和入院时血糖均与非糖尿病患者复合终点风险增加密切相关。然而，仅入院时血糖/ eAG（比值比=2.45，95%置信区间：1.24-4.82，P=0.010）与糖尿病患者的结局相关。与入院时血糖相比，入院时血糖/ eAG 在非糖尿病患者中具有等效的预测价值，但在糖尿病患者中具有更好的鉴别能力（AUC 从 0.52-0.63 提高，P<0.001）。综上所述，与入院时血糖相比，入院时血糖/ eAG 在接受 PCI 的糖尿病合并 STEMI 患者中提供了更显著的院内预后信息。
