An acute-to-chronic glycemic ratio >1.22 better predicted plaque rupture, lipid-rich plaque, and thin-cap fibroatheroma than acute blood glucose >140 mg/dl in nondiabetic AMI patients.
Does admission hyperglycemia predict vulnerable culprit lesion characteristics in non-diabetic patients with acute myocardial infarction?
In non-diabetic patients with acute myocardial infarction, an elevated acute-to-chronic glycemic ratio (A/C > 1.22) is a strong predictor of vulnerable culprit plaque characteristics on optical coherence tomography.
Absolute Event Rate: 0% vs 0%
Background . Hyperglycemia is frequently observed in acute myocardial infarction (AMI). Diabetes mellitus (DM) patients and non-DM patients have different culprit lesion phenotypes and few data are available on non-DM patients with admission hyperglycemia. Therefore, we aimed to investigate the association between admission hyperglycemia and culprit lesion characteristics using optical coherence tomography (OCT) in AMI patients. Methods and Results . We consecutively enrolled 434 patients with AMI, and 277 patients were included in analysis: 65.7% (n=182) non-DM patients and 34.3% (n=95) DM patients. We measured acute blood glucose (ABG) and hemoglobin A 1c to calculate the acute-to-chronic glycemic ratio (A/C). Then, we grouped non-DM patients into tertiles of A/C. OCT-based culprit lesion characteristics were compared across A/C tertiles in non-DM patients and between DM and non-DM patients. Non-DM patients had fewer lipid-rich plaques (52.7% versus 68.4%, p=0.012) and thin-cap fibroatheroma (TCFA) (19.8% versus 34.7%, p=0.006) than DM patients but similar prevalence of plaque rupture (47.3% versus 56.8%, p=0.130). Non-DM patients with the highest A/C tertile had the highest prevalence of plaque rupture (pfor trend=0.002), lipid-rich plaque (pfor trend=0.001), and TCFA (pfor trend=0.003). A/C>1.22 but not ABG>140 mg/dl predicted a high prevalence of plaque rupture, lipid-rich plaque, and TCFA in non-DM patients. Conclusions . In AMI patients without DM, admission hyperglycemia is associated with vulnerable culprit lesion characteristics, and A/C is a better predictor for vulnerable culprit plaque characteristics than ABG. These results call for a tailored evaluation and management of glucose metabolism in nondiabetic AMI patients. This trial is registered with NCT03593928 .
Zhou et al. (Mon,) reported a other. An acute-to-chronic glycemic ratio >1.22 better predicted plaque rupture, lipid-rich plaque, and thin-cap fibroatheroma than acute blood glucose >140 mg/dl in nondiabetic AMI patients.