Alkatiri Abdul Hakim, Qalby Nurul, Mappangara Idar, Zainal Ahmad Taufik F, Cramer Maarten J, Doevendans Pieter A, Qanitha Andriany
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
Makassar Cardiac Center, Dr. Wahidin Sudirohusodo General Teaching Hospital, Makassar, Indonesia.
Front Cardiovasc Med. 2024 Mar 11;11:1303685. doi: 10.3389/fcvm.2024.1303685. eCollection 2024.
Hyperglycemia, characterized by elevated blood glucose levels, is frequently observed in patients with acute coronary syndrome, including ST-elevation myocardial infarction (STEMI). There are conflicting sources regarding the relationship between hyperglycemia and outcomes in STEMI patients. We aimed to compile evidence to assess the association between hyperglycemia and adverse outcomes.
We conducted a comprehensive search for articles on PubMed and Embase using search strategies which yielded 4,061 articles. After full-text screening, 66 articles were included for systematic review, and 62 articles were further selected for meta-analysis.
The 66 included articles spanned the years 2005-2023. Of these, 45 articles reported admission blood glucose, 13 articles used HbA1c, and 7 articles studied fasting blood glucose. Most studies defined STEMI with primary PCI as their inclusion criteria. Mortality was the most often outcome reported related to hyperglycemia. Overall, 55 (83.3%) studies were at low risk of bias. Both admission and fasting blood glucose were significantly related to short- and long-term mortality after STEMI, with a pooled risk ratio (RR) of 3.02 (95%CI: 2.65-3.45) and 4.47 (95% CI: 2.54-7.87), respectively. HbA1c showed substantial association with long-term mortality (HR 1.69, 95% CI: 1.31-2.18)) with a pooled RR of 1.58 (95% CI 1.26-1.97). In subsequent analyses, admission hyperglycemia was associated with an increased risk of reinfarction (pooled RR 1.69, 95% CI 1.31-2.17), heart failure (pooled RR 1.56, 95% CI: 1.37-1.77), cardiogenic shock (pooled RR 3.68, 95% CI 2.65-5.11), repeat PCI or stent thrombosis (pooled RR 1.99, 95% CI 1.21-3.28), and composite major adverse cardiac and cerebrovascular events (MACCE) (pooled RR 1.99, 95% CI: 1.54-2.58).
Our study demonstrated that hyperglycemia has a strong association with poor outcomes after STEMI. Admission and fasting blood glucose are predictors for short-term outcomes, while HbA1c is more appropriate for predicting longer-term outcomes in STEMI patients.
PROSPERO 2021 (CRD42021292985).
以血糖水平升高为特征的高血糖症在急性冠状动脉综合征患者中经常出现，包括ST段抬高型心肌梗死（STEMI）。关于STEMI患者高血糖与预后之间的关系，存在相互矛盾的资料来源。我们旨在收集证据以评估高血糖与不良预后之间的关联。
我们使用检索策略在PubMed和Embase上全面检索文章，共获得4061篇文章。经过全文筛选，纳入66篇文章进行系统评价，进一步选择62篇文章进行荟萃分析。
纳入的66篇文章涵盖2005年至2023年。其中，45篇文章报告了入院时血糖，13篇文章使用糖化血红蛋白（HbA1c），7篇文章研究了空腹血糖。大多数研究将直接经皮冠状动脉介入治疗（primary PCI）定义的STEMI作为纳入标准。死亡率是与高血糖相关最常报告的结局。总体而言，55项（83.3%）研究存在低偏倚风险。入院血糖和空腹血糖均与STEMI后的短期和长期死亡率显著相关，合并风险比（RR）分别为3.02（95%置信区间：2.65 - 3.45）和4.47（95%置信区间：2.54 - 7.87）。HbA1c与长期死亡率有显著关联（风险比1.69，95%置信区间：1.31 - 2.18），合并RR为1.58（95%置信区间1.26 - 1.97）。在后续分析中，入院高血糖与再梗死风险增加相关（合并RR 1.69，95%置信区间1.31 - 2.17）、心力衰竭（合并RR 1.56，95%置信区间：1.37 - 1.77）、心源性休克（合并RR 3.68，95%置信区间2.65 - 5.11）、重复PCI或支架血栓形成（合并RR 1.99，95%置信区间1.21 - 3.28）以及主要不良心脑血管事件复合终点（MACCE）（合并RR 1.99，95%置信区间：1.54 - 2.58）。
我们的研究表明，高血糖与STEMI后的不良预后密切相关。入院血糖和空腹血糖是短期预后的预测指标，而HbA1c更适合预测STEMI患者的长期预后。
PROSPERO 2021（CRD42021292985）
