First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece.
Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
Cardiovasc Diabetol. 2022 Jul 26;21(1):140. doi: 10.1186/s12933-022-01578-6.
Stress induced hyperglycemia (SIH) is common among patients with ST-elevation myocardial infarction (STEMI), even in patients without diabetes mellitus. However, evidence regarding its role on the angiographic outcomes and the prognosis of patients presenting with STEMI is scarce.
This study included 309 consecutively enrolled STEMI patients undergoing primary percutaneous coronary intervention (pPCI). Patients were diagnosed with SIH if blood glucose on admission was > 140 mg/dl. Also, patients had to fast for at least 8 hours before blood sampling. The objective was to assess whether SIH was associated with major adverse cardiovascular and cerebrovascular (MACCE) events and explore its relationship with angiographic predictors of worse prognosis such as poor initial TIMI flow, intracoronary thrombus burden, distal embolization, and presence of residual thrombus after pPCI.
SIH in diabetic and non-diabetic patients was associated with a higher incidence of LTB (aOR = 2.171, 95% CI 1.27-3.71), distal embolization (aOR = 2.71, 95% CI 1.51-4.86), and pre-procedural TIMI flow grade = 0 (aOR = 2.69, 95% CI 1.43-5.04) after adjusting for relevant clinical variables. Importantly, during a median follow-up of 1.7 years STEMI patients with SIH with or without diabetes experienced increased occurrence of MACCE both in univariate (HR = 1.92, 95% CI 1.19-3.01) and multivariate analysis (aHR = 1.802, 95% CI 1.01-3.21).
SIH in STEMI patients with or without diabetes was independently associated with increased MACCE. This could be attributed to the fact that SIH was strongly correlated with poor pre-procedural TIMI flow, LTB, and distal embolization. Large clinical trials need to validate SIH as an independent predictor of adverse angiographic and clinical outcomes to provide optimal individualized care for patients with STEMI.
即使在没有糖尿病的患者中，ST 段抬高型心肌梗死（STEMI）患者也普遍存在应激性高血糖（SIH）。然而，关于其在 STEMI 患者的血管造影结果和预后中的作用的证据仍然很少。
本研究纳入了 309 例连续接受直接经皮冠状动脉介入治疗（pPCI）的 STEMI 患者。入院时血糖＞140mg/dl 的患者被诊断为 SIH。此外，患者在采血前必须至少禁食 8 小时。目的是评估 SIH 是否与主要不良心血管和脑血管事件（MACCE）相关，并探讨其与血管造影预后不良的预测因素（如初始 TIMI 血流较差、冠状动脉内血栓负荷、远端栓塞和 pPCI 后残余血栓）的关系。
在糖尿病和非糖尿病患者中，SIH 与 LTB（优势比[aOR]＝2.171，95%置信区间[CI]为 1.27-3.71）、远端栓塞（aOR＝2.71，95%CI 为 1.51-4.86）和术前 TIMI 血流分级=0（aOR＝2.69，95%CI 为 1.43-5.04）的发生率较高相关，在调整相关临床变量后。重要的是，在中位随访 1.7 年后，无论是否患有糖尿病，有 SIH 的 STEMI 患者在单变量（危险比[HR]＝1.92，95%CI 为 1.19-3.01）和多变量分析（调整危险比[aHR]＝1.802，95%CI 为 1.01-3.21）中均经历了 MACCE 的发生率增加。
无论是否患有糖尿病，STEMI 患者的 SIH 与 MACCE 发生率增加独立相关。这可能是因为 SIH 与术前 TIMI 血流较差、LTB 和远端栓塞密切相关。需要进行大型临床试验来验证 SIH 是否为不良血管造影和临床结局的独立预测因素，以为 STEMI 患者提供最佳的个体化治疗。
