Correlation of Insulin Resistance With Short-Term Outcome in Nondiabetic Patients With ST-Segment Elevation Myocardial Infarction

Abstract

Background: Obviously, hyperglycemia and insulin resistance (IR) are common in patients with acute ST-segment elevation myocardial infarction (STEMI). Additionally, IR is a substantial risk factor for cardiovascular diseases. The study aims to evaluate the association between IR and short-term outcomes of acute STEMI patients without diabetes mellitus in the form of reperfusion success, the occurrence of heart failure, the development of arrhythmias, and mortality.

Method: A cross-sectional study was done from August 2021 to December 2021 in two cardiology centers in Al-Sadr Teaching hospital and Basrah Oil hospital in Basrah, Southern Iraq. Sixty-one nondiabetic hospitalized patients with acute STEMI were included in the study. Twenty-five (41%) of them received thrombolytics and 36 (59%) were managed with percutaneous transluminal coronary angioplasty. From each patient, a fasting blood sample was taken for calculation of the Homeostasis Model Assessment for IR (HOMA-IR) and triglyceride glucose index (TyG) index. The patients were evaluated within 1-week for (reperfusion success, echocardiography for calculation of the ejection fraction (EF), arrhythmias, and mortality), and within 4-weeks for mortality.

Results: Within the tertile 3 of the HOMA-IR and TyG index, significant higher 4-week mortality (35% and 30%, respectively). Pearson correlation also showed significant and negative correlations between both HOMA-IR and TyG index values and EF. While reperfusion success, arrhythmias, and 1-week mortality did not correlate significantly with both HOMA-IR and TyG index.

Conclusion: IR as defined by HOMA-IR and TyG index was significantly associated with poor outcomes in patients with acute STEMI in the form of EF<55 and 4-week mortality.

Keywords: arrhythmias; ejection fraction; mortality; st-segment elevation myocardial infarction; tyg index; • homeostasis model assessment for insulin resistance (homa-ir).

Figure 1. Association between HOMA-IR severity categories and outcomes of acute STEMI.

Fisher’s Exact Test value and P value for the study outcomes including non-successful recanalization (2.28, P = 0.3), arrhythmias (2.24, P = 0.2), EF <55 (8.1, P = 0.01), and 4-week mortality (10.5, P = 0.002). HOMA-IR: homeostatic model assessment for insulin resistance; STEMI: ST-segment elevation myocardial infarction; EF: ejection fraction

Figure 2. Association between TyG index severity categories and outcomes of acute STEMI.

Fisher’s Exact Test value and P value for the study outcomes including non-successful recanalization (0.8, P = 0.7), arrhythmias (2.02, P = 0.3), EF <55 (4.8, P = 0.09), an and 4-weeks mortality (6.1, P = 0.03). TyG index: triglyceride glucose index; STEMI: ST-segment elevation myocardial infarction; EF: ejection fraction

Figure 3. Pearson correlation between early post-STEMI ejection fraction value and HOMA-IR.

(R = -0.3, P = 0.006). HOMA-IR: homeostatic model assessment for insulin resistance; STEMI: ST-segment elevation myocardial infarction

Figure 4. Pearson correlation between early post-STEMI ejection fraction value and TyG index.

(R = -0.32, P = 0.01). TyG index: triglyceride glucose index; STEMI: ST-segment elevation myocardial infarction