The relationship of plasma glucose, stress hyperglycaemia and glycated haemoglobin with intermediate-term mortality after acute myocardial infarction in patients with and without diabetes.
Annalisa Montebello, Martina Agius, Martina Grech, Nicoletta Maniscalco, Ivana Kenkovski, Stephen Fava
Author Information
Annalisa Montebello: Mater Dei Hospital, Msida, Malta. ORCID
Martina Agius: Mater Dei Hospital, Msida, Malta.
Martina Grech: Mater Dei Hospital, Msida, Malta.
Nicoletta Maniscalco: Mater Dei Hospital, Msida, Malta.
Ivana Kenkovski: Mater Dei Hospital, Msida, Malta.
AIMS: Admission hyperglycaemia is an adverse prognostic indicator in the setting of acute myocardial infarction. It is unclear if this is because of previously undiagnosed diabetes, due to admission plasma glucose being a marker of a greater stress hormone response and therefore a more severe event, or due to a detrimental effect of high blood glucose on the myocardium. METHODS: We performed retrospective analysis of a cohort of 430 participants admitted with a diagnosis of acute myocardial infarction. We investigated the relation of admission plasma glucose, glycated haemoglobin, stress hyperglycaemia ratio and a novel parameter; the stress hyperglycaemia index, to mortality by Cox regression analyses. The stress hyperglycaemia index is the difference between the admission glucose and glucose estimated from HbA. RESULTS: We included 430 participants who were followed for a median of 2.5 years. The stress hyperglycaemia index was associated with increased mortality in patients with diabetes in both univariate and multivariate analyses. Admission glucose was associated with mortality in subjects with diabetes in univariate analysis and after adjustment of age and sex, but not after adjusting for eGFR. There was no significant association between admission glucose and mortality in subjects without diabetes. HbA was not associated with mortality in either patient group in both univariate and multivariate analyses. CONCLUSION: Our results suggest a possible detrimental effect of hyperglycaemia in the setting of an acute myocardial infarction.
Fava S, Aquilina O, Azzopardi J, Agius Muscat H, Fenech FF. The prognostic value of blood glucose in diabetic patients with acute myocardial infarction. Diabet Med. 1996;13(1):80‐83.
Gasior M, Stasik‐Pres G, Pres D, et al. Relationship between blood glucose on admission and prognosis in patients with acute myocardial infarction treated with percutaneous coronary intervention. Kardiol Pol. 2007;65(9):1031‐1038.
Hadjadj S, Coisne D, Mauco G, et al. Prognostic value of admission plasma glucose and HbA 1c in acute myocardial infarction. Diabet Med. 2004;21(4):305‐310.
Kewcharoen J, Ali M, Trongtorsak A, Mekraksakit P, Vutthikraivit W, Kanjanauthai S. Admission hyperglycemia is associated with reperfusion failure in patients with ST‐elevation myocardial infarction undergoing primary percutaneous coronary intervention: a systematic review and meta‐analysis. Am J Cardiovasc Dis. 2021;11(3):348‐359.
Meier JJ, Deifuss S, Klamann A, Launhardt V, Schmiegel WH, Nauck MA. Plasma glucose at hospital admission and previous metabolic control determine myocardial infarct size and survival in patients with and without type 2 diabetes. Diabetes Care. 2005;28(10):2551‐2553.
Cheung NW, Wong KYC, Kovoor P, McLean M. Stress hyperglycemia: a prospective study examining the relationship between glucose, cortisol and diabetes in myocardial infarction. J Diabetes Complicat. 2019;33(4):329‐334.
Lee KH, Harrison W, Chow KL, Lee M, Kerr AJ. Cardiogenic shock prior to percutaneous coronary intervention in ST‐elevation myocardial infarction: outcomes and predictors of mortality (ANZACS‐QI 73). Heart Lung Circ. 2024;144(24):38.
Monnier L, Mas E, Ginet C, et al. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA. 2006;295(14):1681.
Battault S, Renguet E, Van Steenbergen A, Horman S, Beauloye C, Bertrand L. Myocardial glucotoxicity: mechanisms and potential therapeutic targets. Arch Cardiovasc Dis. 2020;113(11):736‐748.
Hegyi B, Ko CY, Bossuyt J, Bers DM. Two‐hit mechanism of cardiac arrhythmias in diabetic hyperglycaemia: reduced repolarization reserve, neurohormonal stimulation, and heart failure exacerbate susceptibility. Cardiovasc Res. 2021;117(14):2781‐2793.
Ebel D, Müllenheim J, Frässdorf J, et al. Effect of acute hyperglycaemia and diabetes mellitus with and without short‐term insulin treatment on myocardial ischaemic late preconditioning in the rabbit heart in vivo. Pflugers Arch. 2003;446(2):175‐182.
Malmberg K, Rydén L, Efendic S, et al. Randomized trial of insulin‐glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol. 1995;26(1):57‐65.
Malmberg K, Rydén L, Wedel H, et al. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity. Eur Heart J. 2005;26(7):650‐661.
Pyörälä M, Miettinen H, Laakso M, Pyörälä K. Plasma insulin and all‐cause, cardiovascular, and noncardiovascular mortality: the 22‐year follow‐up results of the Helsinki policemen study. Diabetes Care. 2000;23(8):1097‐1102.
Marfella R, Di Filippo C, Portoghese M, et al. Tight glycemic control reduces heart inflammation and remodeling during acute myocardial infarction in hyperglycemic patients. J Am Coll Cardiol. 2009;53(16):1425‐1436.
Curtis LH, Hammill BG, Bethel MA, et al. Pancreatic β‐cell function as a predictor of cardiovascular outcomes and costs: findings from the cardiovascular health study. Curr Med Res Opin. 2008;24(1):41‐50.
Pan Y, Chen W, Jing J, et al. Pancreatic β‐cell function and prognosis of nondiabetic patients with ischemic stroke. Stroke. 2017;48(11):2999‐3005.
Narumi T, Watanabe T, Kato S, et al. Impact of impaired pancreatic β‐cell function on cardiovascular prognosis in heart failure patients without diabetes mellitus. Circ Rep. 2019;1(6):255‐260.
Sayer JW. Autonomic dysfunction is related to impaired pancreatic beta cell function in patients with coronary artery disease. Heart. 2000;83(2):210‐216.
Ye Q, Zhang J, Ma L. Predictors of all‐cause 1‐year mortality in myocardial infarction patients. Medicine. 2020;99(29):e21288.
Johansson S, Rosengren A, Young K, Jennings E. Mortality and morbidity trends after the first year in survivors of acute myocardial infarction: a systematic review. BMC Cardiovasc Disord. 2017;17(1):53.
