Detrimental Effects of Hyperglycemia in Acute Coronary Syndromes: from Pathophysiological Mechanisms to Therapeutic Strategies

Glycated hemoglobin, admission blood glucose delta, and associated mortality in patients with acute ST-segment elevation myocardial infarction

The importance of glucose metabolism in patients with acute coronary syndrome has been increasingly recognized. We conducted a retrospective study of the associations between prior glycated hemoglobin (HbA1c) levels, admission glucose values, HbA1c-derived estimated average glucose levels (eAG), admission glucose delta (admission glucose - eAG), and mortality in patients presenting with ST-segment elevation myocardial infarction. A total of 676 and 566 patients were included in the in-hospital and 12-month mortality models, respectively. Mean admission blood glucose values were higher in the in-hospital and 12-month mortality groups in patients with no prior diagnosis of diabetes (P < 0.001). Pre, post, and admission HbA1c levels and eAG levels were not associated with in-hospital or 12-month all-cause mortality. The admission glucose delta was higher in patients with in-hospital mortality (87.3 ± 122.7 mg/dL) than in patients who survived (35.88 ± 81.23 mg/dL; P = 0.040). The in-hospital death rate was significantly higher (17% vs 4%, P = 0.017) for patients with admission glucose delta ≥140 mg/dL compared to lower values. In conclusion, HbA1c-derived admission glucose delta is associated with in-hospital mortality in patients with ST-segment elevation myocardial infarction. The mechanisms for the association of acute hyperglycemia with increased acute coronary syndrome mortality are unclear.