Fasting blood sugar predicts progression of non-culprit lesions in STEMI patients after primary PCI

Primary PCI can rescue dying myocardium, improve prognosis, and reduce cardiovascular (CV) events in STEMI patients. However, recent studies have shown that non-culprit lesions may advance after PPCI, and NCL progression could significantly impact prognosis after PPCI. However, there is no clarity on the clinical correlation factors for the progression of NCL. Jian Wang from the Department of Cardiology in Xining First People's Hospital, Xining, Qinghai, China, and colleagues aimed to investigate the relationship between clinical features and the progression of non-culprit lesions in STEMI patients after primary PCI.

The authors enrolled 480 STEMI patients (57.1 ± 9.2 y) who underwent primary PCI between January 2016 and December 2017. As a treatment for culprit lesions, all patients underwent primary PCI. Angiographic and clinical follow-up was done for 12 months. Patients were divided into an NCL progression group (n=205) and a control group (n=275) based on follow-up outcomes at 12 months from angiography.

The study led to the following findings:

· In the NCL progression group, Body mass index (BMI), glycated serum albumin, fasting blood sugar (FBG), glycated hemoglobin, serum creatinine (Scr), and homocysteine levels were notably higher than those in the control group.

· A logistic regression analysis revealed that fasting blood sugar (odds ratio 1.274) and Scr (odds ratio 1.020) were independent predictors of NCL progression.

· A partial correlation analysis revealed that FBG was positively correlated with NCL progression (r = 0.231).

· A receiver operating characteristic curve demonstrated that the boundary point of FBG for predicting NCL progression was 5.715 mmol/L, the specificity was 46.4%, and the sensitivity was 74.4%.

"Findings from the study indicate that fasting blood sugar, body mass index, hemoglobin A1c, homocysteine, and glycated albumin may be clinical correlation factors for the progression of non-culprit lesions in STEMI patients after primary PCI," the researchers wrote. "Serum creatinine and FBG were independent predictors of NCL progress after primary PCI in STEMI patients."

The authors suggest the need for further randomized prospective controlled studies as the study is a single-centre retrospective analysis with a relatively small sample size and an absence of detailed intravascular imaging data.

Reference:

Wang, J., Yan, Cy., Wang, W. et al. The clinical prediction factors for non-culprit lesion progression in patients with acute ST elevation myocardial infarction after primary percutaneous coronary intervention. BMC Cardiovasc Disord 22, 529 (2022). https://doi.org/10.1186/s12872-022-02974-2