Elevated Glucose on Admission Was an Independent Risk Factor for 30-Day Major Adverse Cardiovascular Events in Patients with STEMI but Not NSTEMI

Abstract

Background: The purpose of this study was to evaluate the impact of glucose levels on admission, on the risk of 30-day major adverse cardiovascular events (MACEs) in patients with acute myocardial infarction (AMI), and to assess the difference in outcome between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients.

Methods: This study was a post hoc analysis of the Acute Coronary Syndrome Quality Improvement in Kerala Study, and 13,398 participants were included in the final analysis. Logistic regression models were used to assess the association between glucose levels on admission and the risk of 30-day MACEs, adjusting for potential confounders.

Results: Participants were divided according to the glucose quintiles. There was a positive linear association between glucose levels at admission and the risk of 30-day MACEs in AMI patients [adjusted OR (95% CI): 1.05 (1.03, 1.07), p $<$ 0.001]. Compared to participants with an admission glucose between 5.4 and 6.3 mmol/L, participants with the highest quintile of glucose level ( $\ge$ 10.7 mmol/L) were associated with increased risk of 30-day MACEs in the fully adjusted logistic regression model [adjusted OR (95% CI): 1.82 (1.33, 2.50), p $<$ 0.001]. This trend was more significant in patients with STEMI (p for interaction = 0.036).

Conclusions: In patients with AMI, elevated glucose on admission was associated with an increased risk of 30-day MACEs, but only in patients with STEMI.

Keywords: ST-elevation myocardial infarction; glucose; major adverse cardiovascular events; non-ST-elevation myocardial infarction.

Fig. 1.

Estimated risk of MACEs in different blood glucose levels for total participants. The solid red line was the estimated risk, and the dashed lines above and below were the upper and lower limits of 95% CI, respectively. All covariates in model 3 were adjusted. MACEs, major adverse cardiovascular events; OR, odds ratio; CI, confidence interval.

Fig. 2.

Estimated risk of MACEs in different blood glucose levels stratified by MI type. All covariates in model 3 were adjusted. MACEs, major adverse cardiovascular events; STEMI, ST-segment elevation myocardial infarction; NSTEMI, non-ST-segment elevation myocardial infarction; MI, myocardial infarction; OR, odds ratio; CI, confidence interval.