Prognostic value of fasting glucose on the risk of heart failure and left ventricular systolic dysfunction in non-diabetic patients with ST-segment elevation myocardial infarction

Abstract

Recent studies have shown that acute blood glucose elevation in patients with ST-segment elevation myocardial infarction (STEMI) suggests a poor prognosis. To investigate the effect of fasting blood glucose (FBG) on the risk of heart failure (HF) and left ventricular systolic dysfunction (LVSD) in non-diabetic patients undergoing primary percutaneous coronary intervention (PCI) for acute STEMI, we retrospectively recruited consecutive non-diabetic patients who underwent primary PCI for STEMI in our hospital from February 2003 to March 2015. The patients were divided into two groups according to the FBG level. A total of 623 patients were recruited with an age of 61.3 ± 12.9 years, of whom 514 (82.5%) were male. The HF risk (odds ratio 3.401, 95% confidence interval (CI) 2.144–5.395, P < 0.001) was significantly increased in patients with elevated FBG than those with normal FBG. Elevated FBG was also independently related to LVSD (β 1.513, 95%CI 1.282–1.785, P < 0.001) in a multiple logistics regression analysis. In conclusion, elevated FBG was independently associated with 30-day HF and LVSD risk in non-diabetic patients undergoing primary PCI for STEMI.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Reed GW, Rossi JE, Cannon CP. Acute myocardial infarction. Lancet 2017; 389(10065): 197–197

    Article  Google Scholar 

  2. 2.

    Ezekowitz JA, Kaul P, Bakal JA, Armstrong PW, Welsh RC, McAlister FA. Declining in-hospital mortality and increasing heart failure incidence in elderly patients with first myocardial infarction. J Am Coll Cardiol 2009; 53(1): 13–13

    Article  Google Scholar 

  3. 3.

    Li J, Li X, Wang Q, Hu S, Wang Y, Masoudi FA, Spertus JA, Krumholz HM, Jiang L; China PEACE Collaborative Group. STsegment elevation myocardial infarction in China from 2001 to 2011 (the China PEACE-Retrospective Acute Myocardial Infarction Study): a retrospective analysis of hospital data. Lancet 2015; 385(9966): 441–441

    Article  Google Scholar 

  4. 4.

    Timmer JR, Hoekstra M, Nijsten MW, van der Horst IC, Ottervanger JP, Slingerland RJ, Dambrink JH, Bilo HJ, Zijlstra F, van’t Hof AW. Prognostic value of admission glycosylated hemoglobin and glucose in nondiabetic patients with ST-segmentelevation myocardial infarction treated with percutaneous coronary intervention. Circulation 2011; 124(6): 704–704

    CAS  Article  Google Scholar 

  5. 5.

    Planer D, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Xu K, Fahy M, Mehran R, Stone GW. Impact of hyperglycemia in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: the HORIZONS-AMI trial. Int J Cardiol 2013; 167(6): 2572–2572

    Article  Google Scholar 

  6. 6.

    Lønborg J, Vejlstrup N, Kelbæk H, Nepper-Christensen L, Jørgensen E, Helqvist S, Holmvang L, Saunamäki K, Bøtker HE, Kim WY, Clemmensen P, Treiman M, Engstrøm T. Impact of acute hyperglycemia on myocardial infarct size, area at risk, and salvage in patients with STEMI and the association with exenatide treatment: results from a randomized study. Diabetes 2014; 63(7): 2474–2474

    Article  Google Scholar 

  7. 7.

    Suleiman M, Hammerman H, Boulos M, Kapeliovich MR, Suleiman A, Agmon Y, Markiewicz W, Aronson D. Fasting glucose is an important independent risk factor for 30-day mortality in patients with acute myocardial infarction: a prospective study. Circulation 2005; 111(6): 754–754

    CAS  Article  Google Scholar 

  8. 8.

    Kosiborod M, Rathore SS, Inzucchi SE, Masoudi FA, Wang Y, Havranek EP, Krumholz HM. Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes. Circulation 2005; 111(23): 3078–3078

    CAS  Article  Google Scholar 

  9. 9.

    Ishihara M, Kojima S, Sakamoto T, Kimura K, Kosuge M, Asada Y, Tei C, Miyazaki S, Sonoda M, Tsuchihashi K, Yamagishi M, Shirai M, Hiraoka H, Honda T, Ogata Y, Ogawa H; Japanese Acute Coronary Syndrome Study (JACSS) Investigators. Comparison of blood glucose values on admission for acute myocardial infarction in patients with versus without diabetes mellitus. Am J Cardiol 2009; 104(6): 769–769

    CAS  Article  Google Scholar 

  10. 10.

    Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39(2): 119–119

    Article  Google Scholar 

  11. 11.

    McCullough PA. Contrast-induced acute kidney injury. J Am Coll Cardiol 2008; 51(15): 1419–1419

    Article  Google Scholar 

  12. 12.

    Kowalczyk J, Mazurek M, Zielinska T, Lenarczyk R, Sedkowska A, Swiatkowski A, Sredniawa B, Mencel G, Francuz P, Kalarus Z. Prognostic significance of HbA1c in patients with AMI treated invasively and newly detected glucose abnormalities. Eur J Prev Cardiol 2015; 22(6): 798–798

    Article  Google Scholar 

  13. 13.

    Gholap NN, Mehta RL, Ng L, Davies MJ, Khunti K, Squire IB. Is admission blood glucose concentration a more powerful predictor of mortality after myocardial infarction than diabetes diagnosis? A retrospective cohort study. BMJ Open 2012; 2(5): e001596

    Article  Google Scholar 

  14. 14.

    Yang SW, Zhou YJ, Liu YY, Hu DY, Shi YJ, Nie XM, Gao F, Hu B, Jia DA, Fang Z, Han HY, Wang JL, Hua Q, Li HW; Beijing Elderly Acute Myocardial Infarction Study (BEAMIS) Group. Influence of abnormal fasting plasma glucose on left ventricular function in older patients with acute myocardial infarction. Angiology 2012; 63(4): 266–266

    Article  Google Scholar 

  15. 15.

    Kim EJ, Jeong MH, Kim JH, Ahn TH, Seung KB, Oh DJ, Kim HS, Gwon HC, Seong IW, Hwang KK, Chae SC, Kim KB, Kim YJ, Cha KS, Oh SK, Chae JK; KAMIR-NIH registry investigators. Clinical impact of admission hyperglycemia on in-hospital mortality in acute myocardial infarction patients. Int J Cardiol 2017; 236: 9–15

    Article  Google Scholar 

  16. 16.

    Leor J, Goldbourt U, Reicher-Reiss H, Kaplinsky E, Behar S. Cardiogenic shock complicating acute myocardial infarction in patients without heart failure on admission: incidence, risk factors, and outcome. Am J Med 1993; 94(3): 265–265

    CAS  Article  Google Scholar 

  17. 17.

    Oswald GA, Smith CC, Betteridge DJ, Yudkin JS. Determinants and importance of stress hyperglycaemia in non-diabetic patients with myocardial infarction. Br Med J (Clin Res Ed) 1986; 293(6552): 917–917

    CAS  Article  Google Scholar 

  18. 18.

    Marfella R, Di Filippo C, Portoghese M, Ferraraccio F, Rizzo MR, Siniscalchi M, Musacchio E, D’Amico M, Rossi F, Paolisso G. Tight glycemic control reduces heart inflammation and remodeling during acute myocardial infarction in hyperglycemic patients. J Am Coll Cardiol 2009; 53(16): 1425–1425

    CAS  Article  Google Scholar 

  19. 19.

    Tousoulis D, Papageorgiou N, Androulakis E, Siasos G, Latsios G, Tentolouris K, Stefanadis C. Diabetes mellitus-associated vascular impairment: novel circulating biomarkers and therapeutic approaches. J Am Coll Cardiol 2013; 62(8): 667–667

    CAS  Article  Google Scholar 

  20. 20.

    Yahagi K, Kolodgie FD, Lutter C, Mori H, Romero ME, Finn AV, Virmani R. Pathology of human coronary and carotid artery atherosclerosis and vascular calcification in diabetes mellitus. Arterioscler Thromb Vasc Biol 2017; 37(2): 191–191

    CAS  Article  Google Scholar 

  21. 21.

    Stegenga ME, van der Crabben SN, Levi M, de Vos AF, Tanck MW, Sauerwein HP, van der Poll T. Hyperglycemia stimulates coagulation, whereas hyperinsulinemia impairs fibrinolysis in healthy humans. Diabetes 2006; 55(6): 1807–1807

    CAS  Article  Google Scholar 

  22. 22.

    Kristiansen SB, Pælestik KB, Johnsen J, Jespersen NR, Pryds K, Hjortbak MV, Jensen RV, Bøtker HE. Impact of hyperglycemia on myocardial ischemia-reperfusion susceptibility and ischemic preconditioning in hearts from rats with type 2 diabetes. Cardiovasc Diabetol 2019; 18(1): 66

    Article  Google Scholar 

  23. 23.

    Kersten JR, Toller WG, Tessmer JP, Pagel PS, Warltier DC. Hyperglycemia reduces coronary collateral blood flow through a nitric oxide-mediated mechanism. Am J Physiol Heart Circ Physiol 2001; 281(5): H2097–H2104

    CAS  Article  Google Scholar 

  24. 24.

    Kümler T, Gislason GH, Køber L, Torp-Pedersen C. Persistence of the prognostic importance of left ventricular systolic function and heart failure after myocardial infarction: 17-year follow-up of the TRACE register. Eur J Heart Fail 2010; 12(8): 805–805

    Article  Google Scholar 

  25. 25.

    Fujino M, Ishihara M, Honda S, Kawakami S, Yamane T, Nagai T, Nakao K, Kanaya T, Kumasaka L, Asaumi Y, Arakawa T, Tahara Y, Nakanishi M, Noguchi T, Kusano K, Anzai T, Goto Y, Yasuda S, Ogawa H. Impact of acute and chronic hyperglycemia on in-hospital outcomes of patients with acute myocardial infarction. Am J Cardiol 2014; 114(12): 1789–1789

    Article  Google Scholar 

  26. 26.

    Marenzi G, Lauri G, Assanelli E, Campodonico J, De Metrio M, Marana I, Grazi M, Veglia F, Bartorelli AL. Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. J Am Coll Cardiol 2004; 44(9): 1780–1780

    Article  Google Scholar 

  27. 27.

    Sadeghi HM, Stone GW, Grines CL, Mehran R, Dixon SR, Lansky AJ, Fahy M, Cox DA, Garcia E, Tcheng JE, Griffin JJ, Stuckey TD, Turco M, Carroll JD. Impact of renal insufficiency in patients undergoing primary angioplasty for acute myocardial infarction. Circulation 2003; 108(22): 2769–2769

    Article  Google Scholar 

  28. 28.

    Stolker JM, McCullough PA, Rao S, Inzucchi SE, Spertus JA, Maddox TM, Masoudi FA, Xiao L, Kosiborod M. Pre-procedural glucose levels and the risk for contrast-induced acute kidney injury in patients undergoing coronary angiography. J Am Coll Cardiol 2010; 55(14): 1433–1433

    CAS  Article  Google Scholar 

  29. 29.

    Shacham Y, Gal-Oz A, Leshem-Rubinow E, Arbel Y, Keren G, Roth A, Steinvil A. Admission glucose levels and the risk of acute kidney injury in nondiabetic ST segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Cardiorenal Med 2015; 5(3): 191–191

    CAS  Article  Google Scholar 

  30. 30.

    Malmberg K, Rydén L, Wedel H, Birkeland K, Bootsma A, Dickstein K, Efendic S, Fisher M, Hamsten A, Herlitz J, Hildebrandt P, MacLeod K, Laakso M, Torp-Pedersen C, Waldenström A; DIGAMI 2 Investigators. 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): 650–650

    CAS  Article  Google Scholar 

  31. 31.

    Cheung NW, Wong VW, McLean M. The Hyperglycemia: Intensive Insulin Infusion in Infarction (HI-5) study: a randomized controlled trial of insulin infusion therapy for myocardial infarction. Diabetes Care 2006; 29(4): 765–765

    CAS  Article  Google Scholar 

Download references

Acknowledgements

This work was supported by the CAMS Innovation Fund for Medical Sciences (CIFMS) (Nos. 2016-I2M-3-011 and 2016-I2M-1-002).

Author information

Affiliations

Authors

Corresponding authors

Correspondence to Zhenyu Liu or Shuyang Zhang.

Ethics declarations

ui Wang, Yang Zhang, Zhujun Shen, Ligang Fang, Zhenyu Liu, and Shuyang Zhang declare that they have no conflict of interests. All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients that were included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wang, H., Zhang, Y., Shen, Z. et al. Prognostic value of fasting glucose on the risk of heart failure and left ventricular systolic dysfunction in non-diabetic patients with ST-segment elevation myocardial infarction. Front. Med. 15, 70–78 (2021). https://doi.org/10.1007/s11684-020-0749-x

Download citation

Keywords

  • myocardial infarction
  • percutaneous coronary intervention
  • diabetes mellitus
  • fasting glucose
  • heart failure