Plasma random glucose levels at hospital admission predicting worse outcomes in STEMI patients undergoing PCI: A case series

The Glucose-to-Lymphocyte Ratio Predicts All-cause Mortality and Cardiovascular Mortality in ST-Elevation Myocardial Infarction Patients: A Retrospective Study

Background

Systemic inflammation and glucose metabolism are strongly associated with survival in ST-elevation myocardial infarction (STEMI) patients. Therefore, we aimed to assess whether the glucose-to-lymphocyte ratio (GLR) could be used to predict the prognosis of STEMI patients who received emergency percutaneous coronary intervention (PCI) treatment.

Methods

The GLR was calculated as follows: GLR = glucose (mg/dL) / lymphocyte count (K/μL). Patients were divided into two groups according to the median GLR, with the low-GLR group (GLR <81) employed as the reference group. We used Cox proportional hazard regression analyses to determine the predictive value of clinical indicators. Kaplan‒Meier curves were used to plot survival curves for both groups. The receiver operating characteristic (ROC) curves were used to assess the predictive value of the GLR for the risk of all-cause mortality and cardiovascular mortality in STEMI patients. Meanwhile, to evaluate the predictive effectiveness of the models, we plotted the ROC curves for each model.

Results

We retrospectively analyzed 1086 newly admitted patients with STEMI who underwent emergency PCI at the First Affiliated Hospital of Kunming Medical University from June 2018 to January 2023 (mean follow-up time, M ± standard deviation (SD): 1100.66 ± 539.76 days). The results showed that high GLR was associated with increased risks of all-cause mortality (hazard ratio (HR) = 2.530, 95% CI = 1.611-3.974, p < 0.001) and cardiovascular mortality (HR = 3.859, 95% CI = 2.225-6.691, p < 0.001). The optimal GLR threshold for predicting all-cause and cardiovascular death was 79.61 (K/μL), with a ROC for all-cause death of 0.678 (95% CI: 0.625-0.732, p < 0.001), a sensitivity of 77.4%, a specificity of 51.9%, and a ROC for cardiovascular death of 0.716 (95% CI: 0.666-0.767, p < 0.001), with a sensitivity of 88.4% and a specificity of 52.1%.

Conclusions

The GLR may potentially predict all-cause mortality and cardiovascular mortality in STEMI patients who received emergency PCI treatment. A high GLR was associated with a greater risk of all-cause mortality and cardiovascular mortality in STEMI patients.

Stress hyperglycemia and poor outcomes in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis

Background

Hyperglycemia, characterized by elevated blood glucose levels, is frequently observed in patients with acute coronary syndrome, including ST-elevation myocardial infarction (STEMI). There are conflicting sources regarding the relationship between hyperglycemia and outcomes in STEMI patients. We aimed to compile evidence to assess the association between hyperglycemia and adverse outcomes.

Methods

We conducted a comprehensive search for articles on PubMed and Embase using search strategies which yielded 4,061 articles. After full-text screening, 66 articles were included for systematic review, and 62 articles were further selected for meta-analysis.

Results

The 66 included articles spanned the years 2005-2023. Of these, 45 articles reported admission blood glucose, 13 articles used HbA1c, and 7 articles studied fasting blood glucose. Most studies defined STEMI with primary PCI as their inclusion criteria. Mortality was the most often outcome reported related to hyperglycemia. Overall, 55 (83.3%) studies were at low risk of bias. Both admission and fasting blood glucose were significantly related to short- and long-term mortality after STEMI, with a pooled risk ratio (RR) of 3.02 (95%CI: 2.65-3.45) and 4.47 (95% CI: 2.54-7.87), respectively. HbA1c showed substantial association with long-term mortality (HR 1.69, 95% CI: 1.31-2.18)) with a pooled RR of 1.58 (95% CI 1.26-1.97). In subsequent analyses, admission hyperglycemia was associated with an increased risk of reinfarction (pooled RR 1.69, 95% CI 1.31-2.17), heart failure (pooled RR 1.56, 95% CI: 1.37-1.77), cardiogenic shock (pooled RR 3.68, 95% CI 2.65-5.11), repeat PCI or stent thrombosis (pooled RR 1.99, 95% CI 1.21-3.28), and composite major adverse cardiac and cerebrovascular events (MACCE) (pooled RR 1.99, 95% CI: 1.54-2.58).

Conclusions

Our study demonstrated that hyperglycemia has a strong association with poor outcomes after STEMI. Admission and fasting blood glucose are predictors for short-term outcomes, while HbA1c is more appropriate for predicting longer-term outcomes in STEMI patients.

Systematic Review Registration

PROSPERO 2021 (CRD42021292985).

In Vitro Exposure to Glucose Alters the Expression of Phosphorylated Proteins in Platelets

Diabetes mellitus (DM) is a pro-thrombotic state that can potentially cause serious cardiovascular complications. Platelet hyperactivation plays an important role in these pathological processes, however there is little or no information on the effect of hyperglycemia on platelet proteins. The aim of this study was to identify the molecular targets associated with platelet reactivity under hyperglycemia. Towards this goal, we examined the effects of the exposure of platelets to 1 and 2 h glucose (300 mg/dL) and control (vehicle and osmolality control using mannitol) on platelet proteins (n = 4 samples per group) using two-dimensional fluorescence difference gel electrophoresis (2D-DIGE) combined with MALDI-TOF/TOF tandem mass spectrometry. Two-hour exposure to glucose significantly up-regulated the expression of ATP synthase subunit beta, filamin-A, and L-lactate dehydrogenase A chain in platelets. Pro-Q Diamond staining confirmed the effect of 2 h glucose on vinculin, heat shock protein HSP 90-alpha, filamin-A, and fructose-bisphosphate aldolase A (platelet phosphorylated proteins). The identified proteins are involved in various cellular processes and functions and possibly in platelet reactivity under hyperglycemic conditions.