Kirmani Tooba Ahmed, Singh Manjeet, Kumar Sumeet, Kumar Karan, Parkash Om, Yasmin Farah, Khan Farmanullah, Chughtai Najeebullah, Asghar Muhammad Sohaib
Dow University of Health Sciences, Karachi, Pakistan.
Liaquat National Hospital and Medical College, Karachi, Pakistan.
Ann Med Surg (Lond). 2022 May 29;78:103857. doi: 10.1016/j.amsu.2022.103857. eCollection 2022 Jun.
The effects of impaired plasma glucose levels on predicting clinical outcomes and in-hospital events in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) is unknown. Therefore, we evaluated random blood glucose at admission and its association with clinical outcomes in STEMI patients treated with PCI.
Patients with STEMI undergoing PCI were enrolled and were divided into 4 tertiles according to random blood glucose levels. Tertile 1 had levels below 100 mg/dL, tertile 2 had 100-200 mg/dL, tertile 3 had 200-300 mg/dL, and tertile 4 had random blood glucose levels >300 mg/dL. The cumulative rates of in-hospital mortality and major adverse cardiovascular events were calculated.
Both the incidence of all-cause deaths and cumulative rates of major adverse cardiovascular events were significantly the lowest in patients within tertile 1. The cumulative incidence of in-hospital events was 14.3% in tertile 1, 17.6% in tertile 2, 23.5% in tertile 3, and 30.8% in tertile 4. The odds ratio of major adverse cardiovascular events was 1.286 [0.397-4.161] in tertile 2, 1.846 [0.492-6.927] in tertile 3, and 2.667 [0.693-10.254] in tertile 4. The cumulative proportion of adverse events was seen higher in tertile 4 on Kaplan-Meier log-rank (chi-square: 8.094, p = 0.044).
Poor glycemic control or stress hyperglycemia on admission experienced the highest rates of major adverse cardiovascular events including deaths. Plasma random glucose was predictive of a worse prognosis for STEMI patients undergoing PCI in our study.
血糖水平受损对接受经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者临床结局及院内事件的预测作用尚不清楚。因此，我们评估了STEMI患者入院时的随机血糖及其与接受PCI治疗患者临床结局的关联。
纳入接受PCI治疗的STEMI患者，并根据随机血糖水平分为4个三分位数组。三分位数1组血糖水平低于100mg/dL，三分位数2组为100 - 200mg/dL，三分位数3组为200 - 300mg/dL，三分位数4组随机血糖水平>300mg/dL。计算院内死亡率和主要不良心血管事件的累积发生率。
三分位数1组患者的全因死亡率和主要不良心血管事件累积发生率均显著最低。三分位数1组院内事件累积发生率为14.3%，三分位数2组为17.6%，三分位数3组为23.5%，三分位数4组为30.8%。三分位数2组主要不良心血管事件的比值比为1.286[0.397 - 4.161]，三分位数3组为1.846[0.492 - 6.927]，三分位数4组为2.667[0.693 - 10.254]。根据Kaplan - Meier对数秩检验（卡方值：8.094，p = 0.044），三分位数4组不良事件累积比例更高。
入院时血糖控制不佳或应激性高血糖的患者发生包括死亡在内的主要不良心血管事件的发生率最高。在我们的研究中，血浆随机血糖可预测接受PCI治疗的STEMI患者预后较差。
