血管学: オープンアクセス
オープンアクセス

概要

Effects of Hyperglycemia on the In-hospital and Long-term Prognosis of Patients with Acute ST-segment Elevation Myocardial Infarction

Yuhan Qin, Gaoliang Yan, Erfei Luo, Changle Ma, Juchuan Liu, Hao Qian, Zhongxing Peng, Chengchun Tang and Genshan Ma

Objective: A large amount of acute ST-segment elevation myocardial infarction (STEMI) patients have stress hyperglycemia on admission, which is associated with poor in-hospital and long-term prognosis. This research aimed to find the effects of hyperglycemia on in-hospital mortality, adverse cardiovascular events and long-term prognosis in patients with STEMI.
Method: We conducted a prospective cohort study on 456 STEMI patients from January 2015 to December 2016 in Zhongda hospital affiliated to Southeast University. We recorded the baseline data, then used propensity matching (a ratio of 1:2) to balance the confounding variables and rule out the bias, according to the definition of stress hyperglycemia, admission random blood glucose >11.1 mmol/L, we divided patients into two groups: hyperglycemia group (71 cases) and non-hyperglycemia group (142 cases). We recorded and compared the baseline data, past history, auxiliary examination index, medication usage, coronary angiography data, and inhospital outcome between two groups. One-year follow-up main adverse cardiovascular and cerebrovascular events (MACCE) were recorded by telephone and clinic, we use X2 test to research the relationship between hyperglycemia and in-hospital outcome, we use ROC curve to assess the predictive value of hyperglycemia for in-hospital death both in diabetic and non-diabetic patients. Kaplan-Meier curve and Cox regression are used to evaluate the predictive value of stress hyperglycemia for the long-term prognosis.
Result: Stress hyperglycemia occurred in 86 patients (18.9%), of whom 65 had diabetes history. There were 10 patients (14.1%) died in hospital in hyperglycemia group, 6 for malignant arrhythmia, 3 for cardiogenic shock and 1 for cardiac rupture. In the non-hyperglycemia group, the in-hospital mortality is 3.5% (P=0.028). The incidence of malignant arrhythmia and cardiogenic shock were higher in hyperglycemia group than control group (P=0.023, P=0.030). The ROC curve of admission random blood glucose predicting in-hospital deaths for non-diabetic patients and diabetic patients showed the area under curve and 95% CI were 0.627, 0.438 ~ 0.837; 0.786, 0.586 ~ 0.913 respectively. The incidence of one-year follow-up MACCE was about 41.7% in hyperglycemia group, and the incidence in the control group was 27.8% (P=0.018). Gender, age, diabetes, hypertension, previous myocardial infarction, hyperglycemia, left ventricular ejection fraction were included in Cox regression model of one-year followup MACCE in STEMI patients. Stress hyperglycemia was an independent risk factor for one-year follow-up MACCE in STEMI patients (OR=4.398, 95% CI=2.869 ~ 7.483, P<0.001).
Conclusion: Hyperglycemia is a predictive factor for in-hospital death in STEMI patients, and it has good predictive value for the long-term prognosis.