Hyperglycemia elevates the Risk of Stent Restenosis in STEMI Patients
ST-elevation myocardial infarction (STEMI) is one of the leading causes of death and hospitalization worldwide. Acute hyperglycemia is common in patients with a prevalence of 50% in STEMI patients even in the absence of a history of type 2 DM. A recent study suggests that hyperglycemia increases the risk of stent restenosis in ST-elevation myocardial infarction (STEMI) patients. The study findings were published in the journal Diabetes Care in November 2021 issue.
Hyperglycemia (HG) has been shown to adversely affect STEMI clinical outcomes, leading to higher mortality and severe complications. However, the effect of hyperglycemia on the risk of restenosis in STEMI patients without DM remains unclear. Therefore, Dr Pasquale Mone and his team conducted a study to investigate the impact of HG at hospital admission on the risk of restenosis after primary percutaneous coronary intervention (PCI) for STEMI.
The researchers included a total of 336 patients who presented to the hospital with ST-elevation MI (STEMI) and underwent PCI and categorized them into three groups:
Normoglycemic (NG group - n=112).
Hyperglycemic (>140 mg/dL) without diabetes (HG-non-DM group- n=112), and
Hyperglycemic with diabetes (HG-DM group- n=112).
They determined HG as glycemia >140 mg/dL, according to the guidelines of the American Diabetes Association. They treated all patients with STEMI via primary percutaneous coronary intervention, crossed with an angioplasty guidewire followed by bare-metal stents or 2nd-generation drug-eluting stents (DES). They followed all patients for 1 year after the procedure.
Key findings of the study:
- Upon analysis, the researchers found no significant differences among our three groups in terms of the type of stent implanted (percentage of 2nd-generation DES: NG 76.8%, HG-non-DM 76%, HG-DM 77%).
- At 1 year follow-up, they found that 6.5% of NG, 14.0% of HG-non-DM, and 18.5% of HG-DM patients had been rehospitalized for restenosis.
- They confirmed the significant association between restenosis and glycemia at hospital admission in HG-non-DM patients using the Cox proportional hazards regression model after adjusting for other potential risk factors for restenosis, including cholesterol (total and LDL), creatinine, BMI, systolic and diastolic blood pressure, heart rate, age, use of statins, and HbA1c values.
- They also noted that HG may also be a marker for disease severity.
The authors wrote, During the year following the PCI, other factors, including blood pressure control, HbA1c, and lipid levels, all could have affected the risk of restenosis; however, in our regression analysis the association between restenosis and glycemia in HG-non-DM patients remained significant even after accounting for an expanded set of potential risk factors."
They concluded, "The current study is the first to evaluate the effects of HG on the risk of restenosis in STEMI patients without DM, comparing the results to both HG-DM and NG subjects. Taken together, our data indicate that HG is associated with adverse outcomes in STEMI patients independent of DM".
For further information:
DOI: https://doi.org/10.2337/dc21-0939
