Key result
The acute-to-chronic glycemic ratio was significantly associated with an increased risk of no-reflow in patients with ST-segment elevation myocardial infarction undergoing primary PCI (OR 2.274).
Why the study?
No-reflow is a strong and independent predictor of poor cardiovascular outcomes in STEMI, motivating investigation into its association with the acute-to-chronic glycemic ratio after primary PCI.
Is a higher acute-to-chronic glycemic ratio associated with an increased risk of no-reflow in patients with STEMI undergoing primary PCI?
Observational (n=905)
No
Is a higher acute-to-chronic glycemic ratio associated with an increased risk of no-reflow in patients with STEMI undergoing primary PCI?
Odds Ratio: 2.274 (95% CI 1.587–3.26)
p-value: p=<0.001
A higher acute-to-chronic glycemic ratio is a strong independent predictor of no-reflow in patients with STEMI undergoing primary PCI.
May support no-reflow risk stratification in STEMI PCI; leaves open need for prospective validation before clinical use.
BACKGROUND: No‑reflow (NR) is a strong and independent predictor of poor cardiovascular outcomes among patients with ST‑segment elevation myocardial infarction (STEMI). AIMS: The aim of the study was to investigate the association of the acute‑to‑chronic (A/C) glycemic ratio with no‑reflow (NR) in STEMI patients following primary percutaneous coronary intervention (PCI). METHODS: This retrospective study included 905 patients with STEMI. The A/C glycemic ratio was determined as admission blood glucose (ABG) divided by the estimated average glucose (eAG). We evaluated 2 primary models (full model and reduced model). The primary outcome was the presence of NR. RESULTS: The incidence of NR was 22.7% (206 cases) in the present study. We divided the study population into 3 tertiles (T1, T2, and T3) based on the ABG/eAG ratio. There was a stepwise increase of the frequency of NR from the T1 to T3 group (36 patients [12%] vs 70 patients [23%] vs 100 patients [33%]; respectively [P <0.001, for each group comparison]). In a full model, the ABG/eAG ratio (OR, 2.274; 95% CI, 1.587-3.26; P <0.001) was associated with NR. After the performance of a step-down backward variable selection method, the thrombus grade, the ABG/eAG ratio, the infarct‑related artery diameter, and age remained in the reduced model. The ABG/eAG ratio (contributing 25.3% of the explainable outcome in the model) was one of the strong predictors of NR in the reduced model. CONCLUSIONS: To our knowledge, this might be the first study showing a significant relationship between the ABG/eAG ratios with NR in patients with STEMI after primary PCI.
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Şimşek et al. (2021) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=905). Acute-to-chronic (A/C) glycemic ratio vs. Lower A/C glycemic ratio was evaluated on Presence of no-reflow (NR) (OR 2.274, 95% CI 1.587-3.26, p=<0.001). The acute-to-chronic glycemic ratio was significantly associated with an increased risk of no-reflow in patients with ST-segment elevation myocardial infarction undergoing primary PCI (OR 2.274).
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