Yin Xinxin, Pan Xin, Zhang Jingyu, Wu Shuo, Cui Weikai, Wang Yuting, Li Chuanbao, Wang Jiali, Chen Yuguo
Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China.
Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China.
Front Cardiovasc Med. 2024 Oct 9;11:1367704. doi: 10.3389/fcvm.2024.1367704. eCollection 2024.
Although the association between admission glucose (AG) and major adverse cardiac events (MACE) is well-documented, its relationship with 30-day MACE in patients presenting with cardiac chest pain remains unclarified. In light of this, this study aims to examine the correlation between AG levels and the incidence of MACE in patients with chest pain in an emergency setting.
We consecutively enrolled patients who presented to the emergency department for chest pain symptoms within 24 h from the EMPACT cohort in Eastern China (clinicaltrials.gov, Identifier: NCT02536677). The primary outcome was 30-day MACE, including all-cause death, recurrent myocardial infarction, urgent target vessel revascularization, stroke, cardiogenic shock, and cardiac arrest (CA). The associations of AG levels with 30-day MACE were analyzed using Kaplan-Meier analysis and Cox regression models.
Among 1,705 patients who were included in this study, 154 (9.03%) patients met the primary outcome at 30 days. The average age of the patients was 65.23 ± 12.66 years, with 1,028 (60.29%) being male and 500 (29.33%) having diabetes. The median AG levels were 7.60 mmol/L (interquartile range: 6.30-10.20). Kaplan-Meier survival analysis revealed significant differences in the 30-day MACE risk ( < 0.001 according to the log-rank test). We found that the highest AG level (Q4) was associated with increased MACE risk compared with the lowest AG level [adjusted hazard radio (aHR): 2.14; 95% confidence interval (CI): 1.2-3.815; = 0.010]. In addition, Q4 level was also associated with increased all-cause death risk (aHR: 3.825; 95% CI: 1.613-9.07; = 0.002) and increased CA risk (aHR: 3.14; 95% CI: 1.251-7.884; = 0.015).
An elevated AG level significantly correlates with a higher incidence of 30-day MACE in patients with acute chest pain. The findings reveal the importance of managing AG levels to potentially reduce the risk of adverse cardiac events.
尽管入院血糖（AG）与主要不良心脏事件（MACE）之间的关联已有充分记录，但其与胸痛患者30天MACE的关系仍不明确。鉴于此，本研究旨在探讨急诊情况下AG水平与胸痛患者MACE发生率之间的相关性。
我们连续纳入了来自中国东部EMPACT队列中在24小时内因胸痛症状就诊于急诊科的患者（clinicaltrials.gov，标识符：NCT02536677）。主要结局是30天MACE，包括全因死亡、再发心肌梗死、紧急靶血管血运重建、中风、心源性休克和心脏骤停（CA）。使用Kaplan-Meier分析和Cox回归模型分析AG水平与30天MACE的关联。
在本研究纳入的1705例患者中，154例（9.03%）患者在30天时达到主要结局。患者的平均年龄为65.23±12.66岁，其中1028例（60.29%）为男性，500例（29.33%）患有糖尿病。AG水平的中位数为7.60 mmol/L（四分位间距：6.30 - 10.20）。Kaplan-Meier生存分析显示30天MACE风险存在显著差异（对数秩检验P<0.001）。我们发现，与最低AG水平相比，最高AG水平（Q4）与MACE风险增加相关[调整后风险比（aHR）：2.14；95%置信区间（CI）：1.2 - 3.815；P = 0.010]。此外，Q4水平还与全因死亡风险增加（aHR：3.825；95% CI：1.613 - 9.07；P = 0.002）和CA风险增加（aHR：3.14；95% CI：1.251 - 7.884；P = 0.015）相关。
AG水平升高与急性胸痛患者30天MACE的较高发生率显著相关。研究结果揭示了控制AG水平对潜在降低不良心脏事件风险的重要性。
