The study covered in this summary was published in ResearchSquare.com as a preprint and has not yet been peer reviewed.
Key Takeaway
Elevated blood glucose at admission for acute myocardial infarction (MI) significantly predicted major adverse cardiovascular (CV) outcomes at 30 days in patients with ST-segment elevation MI (STEMI), but not in those with non-ST-segment elevation MI (NSTEMI), in an analysis based on a care quality-improvement program.
Why This Matters
Admission biomarkers shown to predict later risk in patients presenting with acute MI could potentially guide post-MI management decisions.
Study Design
The post hoc analysis is based on 13,398 patients in India presenting with acute MI from 2014 to 2016 who were included in a care quality-improvement program and the Acute Coronary Syndrome Quality Improvement in Kerala (ACS-QUIK) study.
Patients were grouped by admission blood glucose level quintile (Q): Q1, 5.3 mmol/L or less; Q2, 5.4 – 6.3 mmol/L (reference); Q3, 6.4 – 7.8 mmol/L; Q4, 7.9 – 10.6 mmol/L, and Q5, 10.7 mmol/L or greater.
Admission glucose levels were evaluated for any effect on 30-day incidence of major adverse CV events (MACE), the composite primary outcome that included death, stroke, reinfarction, and major bleeding.
Associations between 30-day MACE and MI type, and between 30-day MACE and admission glucose levels, were analyzed unadjusted, model 1; minimally adjusted, model 2 (type of intervention, age, sex, and systolic blood pressure), and fully adjusted, model 3 (further adjustment for weight, heart rate, high- and low-density-lipoprotein levels, triglycerides, smoking, diabetes, hypertension, peripheral artery disease, type of MI, symptom-onset-to-arrival time, previous transient ischemic attack or stroke, cardiac arrest on admission, left ventricular ejection fraction, coronary revascularization, antiplatelet agents, and beta blockers).
Associations between outcomes and glucose levels were assessed according to prespecified patient subgroups.
Key Results
Patients with glucose levels in Q5 showed an increased risk for 30-day MACE, compared with patients with levels in Q2 (P < .001 by all three models). The significant odds ratios (ORs) across adjustment models ranged from 1.86 to 1.95.
ORs for admission glucose Q1 and Q3 were not significant in any adjustment model.
Patients with glucose levels in Q4 showed a significantly increased risk in the unadjusted model (P = .025) and minimally adjusted model (P = .029), but not in the fully adjusted model (P = .140).
The risk of 30-day MACE rose in linear fashion with rising admission glucose levels in patients overall and in the STEMI subgroup.
Admission blood glucose was significantly associated with risk for 30-day MACE in patients with STEMI (P < .001), but not those with NSTEMI (P = .393).
The association between admission blood glucose level and risk for 30-day MACE was more strongly significant in patients younger than 65 years (P < .001) than in patients 65 years or older (P = .066).
Limitations
There may have been residual confounding by factors not accounted for in the adjustment models.
Only admission blood glucose data were used; therefore, no relationships involving blood glucose levels during hospitalization could be determined.
Disclosures
The authors declared that they have no competing interests.
This is a summary of a preprint research study, Elevated Admission Blood Glucose Is an Independent Risk Factor for 30-Day Major Adverse Cardiovascular Events in STEMI Patients, but Not in NSTEMI Patients, written by Yanan Li, MPH, Brown University, and colleagues, on Research Square provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on ResearchSquare.com.
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