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  • Glycemic gap within 24...

Glycemic gap within 24 hrs of admission independently predicts MACE and STEMI: Study

Written By : Dr Kartikeya Kohli |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2022-10-15T10:00:31+05:30  |  Updated On 15 Oct 2022 10:01 AM IST
Glycemic gap within 24 hrs of admission independently predicts MACE and STEMI: Study
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China: In patients with acute STEMI, the glycemic gap may predict all-cause mortality and MACE within 30 days, a recent journal Atherosclerosis has found. GAPmean is the difference between mean blood sugar within 24 hours after admission and A1c-derived average glucose (ADAG).

Stress-induced hyperglycemia (SIH) is a common occurrence in critical illness. The glycemic gap (GAP) has recently been considered a superior indicator of SIH. However, there is limited data on the association between GAP and prognosis in ST-segment elevation myocardial infarction (STEMI). Shuang Wu, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China, and colleagues, therefore, aimed to estimate the predictive value of GAPmean in patients with acute STEMI.

The final analysis included a total of 4952 patients with acute STEMI. They were categorized into four groups according to GAPmean quartiles and diabetes mellitus (DM). The primary outcomes were major adverse cardiovascular events (MACEs) and all-cause mortality. The researchers also performed Cox proportional hazards regression analysis and net reclassification improvement (NRI) analysis.

The study led to the following findings:

  • At 30 days of follow-up, 6.5% deaths and 11.5% MACEs.
  • The risk of all-cause mortality (4.0%, 5.6%, 6.5%, and 10.1%) and MACEs (7.3%, 9.6%, 11.4%, and 17.7%) increased remarkably with the elevation of GAPmean.
  • Receiver operating characteristic curve analysis showed that GAPmean was better than admission blood sugar and GAPadm (defined as the difference between ABG and ADAG) for detecting adverse outcomes.
  • Multivariate Cox regression analysis demonstrated that increased GAPmean was independently associated with MACEs and all-cause death.
  • The hazards ratios for all-cause death in the second, third, and fourth quartiles with the first quartile as the reference were respectively 1.49, 1.58, and 2.11, and the HRs for MACEs were 1.40, 1.60, and 2.17, respectively, which were independent diabetes status.
  • Continuous NRI analysis showed that GAPmean significantly improved risk stratification for all-cause mortality and MACEs by 21.6% and 19.8%, respectively.

"The glycemic gap between mean blood glucose level (MGL) within 24 hours after admission and A1c-derived average glucose (ADAG) was linked with 30-day all-cause mortality and MACEs in acute STEMI patients, which was affected by DM status," researchers wrote in their study. "Further, the glycemic gap provided incremental accuracy in STEMI's risk stratification."

To conclude, GAPmean is superior to admission blood sugar and GAPadm for predicting all-cause mortality and MACEs.

Reference:

The "Impact of glycemic gap on 30-day adverse outcomes in patients with acute ST-segment elevation myocardial infarction," was published in Atherosclerosis.

DOI: https://doi.org/10.1016/j.atherosclerosis.2022.10.003


STEMIAtherosclerosis journalGlycemic gapStress-induced hyperglycemiablood sugar variability
Source : Atherosclerosis journal
Dr Kartikeya Kohli
Dr Kartikeya Kohli

    Dr Kartikeya Kohli is an Internal Medicine Consultant at Sitaram Bhartia Hospital in Delhi with super speciality training in Nephrology. He has worked with various eminent hospitals like Indraprastha Apollo Hospital, Sir Gangaram Hospital. He holds an MBBS from Kasturba Medical College Manipal, DNB Internal Medicine, Post Graduate Diploma in Clinical Research and Business Development, Fellow DNB Nephrology, MRCP and ECFMG Certification. He has been closely associated with India Medical Association South Delhi Branch and Delhi Medical Association and has been organising continuing medical education programs on their behalf from time to time. Further he has been contributing medical articles for their newsletters as well. He is also associated with electronic media and TV for conduction and presentation of health programs. He has been associated with Medical Dialogues for last 3 years and contributing articles on regular basis.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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