Department of Cardiology, Liuyang Hospital of Traditional Chinese Medicine, Liuyang, China.
Department of Clinical Medicine, University of South China, Hengyang, China.
Clin Cardiol. 2022 Dec;45(12):1246-1254. doi: 10.1002/clc.23899. Epub 2022 Sep 7.
Glycemic variability in one fact that explain the differences in cardiovascular outcomes. The short-term fasting plasma glucose (FPG) variability may have an on major adverse cardiovascular events (MACE) in type 2 diabetes mellitus (T2DM) patients with ST-segment elevation myocardial infarction (STEMI).
This study retrospectively analyzed T2DM patients who underwent emergent percutaneous coronary intervention (PCI) due to STEMI in Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, between January 2016 and March 2020. All patients underwent at least 5 FPG measurements during the perioperative period. FPG variability score (FPG-VS) was defined as the percentage of the number of FPG variations > 1 mmol/L between two adjacent FPG measurements. The Cox proportional-hazards model was used to estimate the relationship between FPG-VS and MACE. A validation set was utilized to further evaluate the prognostic value of FPG-VS in a standardized STEMI diabetic diet cohort following PCI intervention.
A total of 612 patients were included in the retrospective cohort study. In comparison to the minimum quintile, FPG-VS > 60% was associated with an increased risk of 30-day MACE. Moreover, compared to FPG-VS ≤ 20%, the FPG-VS > 80% group had a higher risk of MACE (odd ratio [OR] = 4.87, 95% confidence interval [CI]: 2.55-5.28), recurrent angina pectoris (OR = 5.43, 95% CI: 2.27-8.27), nonfatal myocardial infarction (OR = 5.00, 95% CI: 2.47-7.69), heart failure (OR = 3.70, 95% CI: 1.92-5.54), malignant arrhythmia (OR = 4.63, 95% CI: 1.12-6.25) and cardiac death (OR = 1.41, 95% CI: 0.17-1.97). Consistent results were obtained after adjustment for HbA1c, demonstrating the robustness of FPGFPG-VS. Moreover, the standard diet intervention group had a lower FPG-VS index as well as a lower incidence of MACE.
Higher FPG variability is associated with an increased risk of MACE within 30 days in diabetes patients receiving PCI for STEMI. A standardized diet may improve the prognosis of STEMI patients by reducing the FPG-VS.
血糖变异性是导致心血管结局差异的一个因素。短期空腹血糖（FPG）变异性可能与 ST 段抬高型心肌梗死（STEMI）的 2 型糖尿病（T2DM）患者的主要不良心血管事件（MACE）有关。
本研究回顾性分析了 2016 年 1 月至 2020 年 3 月在中国医学科学院阜外医院因 STEMI 接受紧急经皮冠状动脉介入治疗（PCI）的 T2DM 患者。所有患者在围手术期至少进行了 5 次 FPG 测量。FPG 变异分数（FPG-VS）定义为两次相邻 FPG 测量值之间 FPG 变化>1mmol/L 的数量百分比。Cox 比例风险模型用于估计 FPG-VS 与 MACE 之间的关系。验证集用于进一步评估 PCI 干预后接受标准化 STEMI 糖尿病饮食的患者中 FPG-VS 的预后价值。
共有 612 名患者纳入回顾性队列研究。与最低五分位数相比，FPG-VS>60%与 30 天 MACE 风险增加相关。此外，与 FPG-VS≤20%相比，FPG-VS>80%组发生 MACE 的风险更高（比值比[OR] = 4.87，95%置信区间[CI]：2.55-5.28）、复发性心绞痛（OR = 5.43，95%CI：2.27-8.27）、非致死性心肌梗死（OR = 5.00，95%CI：2.47-7.69）、心力衰竭（OR = 3.70，95%CI：1.92-5.54）、恶性心律失常（OR = 4.63，95%CI：1.12-6.25）和心脏性死亡（OR = 1.41，95%CI：0.17-1.97）。在调整糖化血红蛋白后得到了一致的结果，证明了 FPG-VS 的稳健性。此外，标准饮食干预组的 FPG-VS 指数较低，MACE 发生率也较低。
在接受 PCI 治疗的 STEMI 糖尿病患者中，较高的 FPG 变异性与 30 天内 MACE 风险增加相关。标准化饮食可能通过降低 FPG-VS 改善 STEMI 患者的预后。
