Key result
Elevated glucose on admission (≥10.7 mmol/L) was independently associated with an increased risk of 30-day MACEs compared to normal levels (OR 1.82) in patients with acute myocardial infarction, an association driven primarily by patients with STEMI.
Why the study?
The study was conducted to evaluate the impact of admission glucose levels on 30-day major adverse cardiovascular events in patients with acute myocardial infarction, and to assess whether outcomes differed between STEMI and NSTEMI.
Does elevated glucose on admission increase the risk of 30-day MACEs in patients with AMI?
Cohort (n=13,398)
Yes
Does elevated glucose on admission increase the risk of 30-day MACEs in patients with AMI?
Odds Ratio: 1.82 (95% CI 1.33–2.5)
Absolute Event Rate: 6.33% vs 3.67%
p-value: p=<0.001
Elevated admission glucose is an independent risk factor for 30-day MACE in patients with STEMI, but not NSTEMI, highlighting the need for differential risk stratification based on AMI type.
Admission hyperglycemia may aid STEMI risk stratification; leaves open whether targeted glucose control reduces 30-day MACE.
Background: The purpose of this study was to evaluate the impact of glucose levels on admission, on the risk of 30-day major adverse cardiovascular events (MACEs) in patients with acute myocardial infarction (AMI), and to assess the difference in outcome between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients. Methods: This study was a post hoc analysis of the Acute Coronary Syndrome Quality Improvement in Kerala Study, and 13,398 participants were included in the final analysis. Logistic regression models were used to assess the association between glucose levels on admission and the risk of 30-day MACEs, adjusting for potential confounders. Results: Participants were divided according to the glucose quintiles. There was a positive linear association between glucose levels at admission and the risk of 30-day MACEs in AMI patients [adjusted OR (95% CI): 1.05 (1.03, 1.07), p < 0.001]. Compared to participants with an admission glucose between 5.4 and 6.3 mmol/L, participants with the highest quintile of glucose level (≥10.7 mmol/L) were associated with increased risk of 30-day MACEs in the fully adjusted logistic regression model [adjusted OR (95% CI): 1.82 (1.33, 2.50), p < 0.001]. This trend was more significant in patients with STEMI (p for interaction = 0.036). Conclusions: In patients with AMI, elevated glucose on admission was associated with an increased risk of 30-day MACEs, but only in patients with STEMI.
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Ma et al. (2024) conducted a cohort in Acute myocardial infarction (STEMI and NSTEMI) (n=13,398). Elevated glucose on admission (≥10.7 mmol/L) vs. Normal admission glucose (5.4-6.3 mmol/L) was evaluated on 30-day major adverse cardiovascular events (MACEs) (OR 1.82, 95% CI 1.33-2.50, p=<0.001). Elevated glucose on admission (≥10.7 mmol/L) was independently associated with an increased risk of 30-day MACEs compared to normal levels (OR 1.82) in patients with acute myocardial infarction, an association driven primarily by patients with STEMI.
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