Hyperglycemia levels may help predict short and long-term outcomes in acute MI patients

China: Regardless of diabetes status, entry hyperglycemia is a key predictor of short and long-term outcomes in acute myocardial infarction (AMI) patients, says an article published in BMC - Cardiovascular Diabetology.

In patients with acute myocardial infarction, admission hyperglycemia is linked with a poor prognosis, although the implications of baseline diabetes status on this connection remain unknown. As a result, Hanzohra Upur and colleagues designed this study to look at the influence of admission hyperglycemia on short and long-term results in diabetic and non-diabetic AMI patients. 

Between July 2012 and July 2020, 3330 individuals with first-time AMI were identified in this retrospective cohort analysis. The participants were separated into two groups based on their diabetes status (1060 diabetic patients and 2270 non-diabetic patients). They were then separated into four groups based on diabetes status-specific fasting blood glucose (FBG) cutoff levels established by a limited cubic spline. In-hospital mortality and heart problems were among the short-term outcomes.

All-cause mortality and significant adverse cardiovascular events were the long-term outcomes (MACE). To account for baseline differences between groups, inverse probability of treatment weighting (IPTW) was used, followed by a weighted Cox proportional hazards regression analysis to quantify hazard ratios and 95% confidence intervals for all-cause mortality related to each FBG category.

The key findings of this study were as follows:

1. 837 people died over a median follow-up of 3.2 years.

2. During long-term follow-up, there was a significant interaction between diabetes status and FBG levels for all-cause death (p-interaction 0.001).

3. Furthermore, limited cubic spline curves for the link between FBG and all-cause mortality resembled a J shape in diabetics and a non-linear form in non-diabetics.

4. A Kaplan-Meier study revealed that non-hyperglycemia patients outlived hyperglycemia patients in both diabetic and non-diabetic patient groups.

5. Patients with hyperglycemia who do not have diabetes had a higher survival rate than patients with hyperglycemia who do have diabetes.

6. Admission hyperglycemia predicted greater short and long-term mortality in the weighted Multivariable Cox analysis.

7. The robustness of the data was demonstrated by subgroup analysis and sensitivity analysis.

FBG levels of 5.60 mmol/L for individuals without diabetes and 10.60 mmol/L for those with diabetes were the inflection points for poor prognosis. Admission hyperglycemia was found to be an independent predictor of poor short and long-term results in AMI patients with and without diabetes. The authors suggested that the key findings of this study merit additional investigation.

Reference: 

Upur, H., Li, J.-L., Zou, X.-G., Hu, Y.-Y., Yang, H.-Y., Abudoureyimu, A., Abliz, A., Abdukerim, M., & Huang, M. (2022). Short and long-term prognosis of admission hyperglycemia in patients with and without diabetes after acute myocardial infarction: a retrospective cohort study. In Cardiovascular Diabetology (Vol. 21, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12933-022-01550-4