Glycemic Gap May Predict ST-Segment elevation MI Associated AKI after PCI in STEMI Patients: Study
China: Researchers have discovered that the glycemic gap (GG) serves as an independent risk factor for acute kidney injury related to ST-segment elevation myocardial infarction (STAAKI) following percutaneous coronary intervention (PCI) in STEMI patients. The study published in BMC Nephrology further demonstrated that including GG in existing risk prediction models markedly improves the ability to forecast STAAKI.
The investigation, conducted by Xiaofu Zhang and colleagues from the Department of Cardiology at The First People’s Hospital of Yuhang District in Hangzhou, China, and colleagues retrospectively analyzed data from 595 patients diagnosed with STEMI who underwent primary PCI. STAAKI, a serious complication that can significantly worsen patient outcomes, was observed in 9.2% of the study population.
The research team employed logistic regression to identify factors linked to the development of STAAKI.
The study revealed the following findings:
- Left ventricular ejection fraction (LVEF), N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels and glycemic gap (GG) were significant independent predictors of ST-segment elevation myocardial infarction-associated acute kidney injury (STAAKI).
- Each 1 mmol/L increase in the glycemic gap was linked to a 37.9% higher risk of developing STAAKI.
- Every 1% increase in LVEF was associated with a reduced risk of STAAKI.
- Higher levels of NT-proBNP correlated with an increased risk of STAAKI.
- Restricted cubic spline analysis demonstrated a linear dose-response relationship between the glycemic gap and STAAKI risk, indicating that the risk rises proportionally as GG increases.
- Incorporating the glycemic gap into existing risk prediction models significantly improved their accuracy, as confirmed by the Delong test, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) statistics.
- This improved risk modeling may help clinicians better identify STEMI patients at risk for acute kidney injury after PCI and optimize treatment strategies.
However, the authors noted several limitations in their study. Being retrospective, the research cannot definitively establish a causal link between elevated glycemic gap and STAAKI. Additionally, the findings are based solely on STEMI patients, so further research is needed to confirm whether GG plays a similar predictive role in other conditions. The biological mechanisms underlying how an increased glycemic gap contributes to kidney injury remain unclear, highlighting the need for additional basic science investigations.
"The study emphasizes the prognostic importance of glycemic gap in STEMI patients undergoing PCI. It suggests that measuring and incorporating GG into clinical risk assessment could improve early identification of patients at heightened risk for acute kidney injury, potentially guiding more personalized treatment strategies," the researchers wrote.
"Future prospective studies are warranted to explore the mechanisms involved and to validate these findings in broader patient populations," they concluded.
Reference:
Zhang, X., Li, Y., Yang, Q. et al. Prognostic value of glycemic gap in ST-segment elevation myocardial infarction-associated acute kidney injury. BMC Nephrol 26, 243 (2025). https://doi.org/10.1186/s12882-025-04167-3
