Association between Admission Blood Glucose and In-Hospital MACE in Non-Diabetic STEMI (Killip I) Patients Undergoing Primary PCI
DOI:
https://doi.org/10.59958/hsf.8145Keywords:
admission blood glucose, non-diabetic, major adverse cardiovascular events, ST-segment elevation myocardial infarction, primary PCIAbstract
Background: The increase in major adverse cardiovascular events (MACE) in patients with diabetes after primary percutaneous coronary intervention (pPCI) is significantly correlated with the admission blood glucose (ABG). However, it is unclear whether ABG in non-diabetic patients is related to MACE after pPCI. We aimed to explore the relationship between ABG and in-hospital MACE in non-diabetic ST-segment elevation myocardial infarction (STEMI) patients with Killip class I treated with pPCI. Methods: The Chinese STEMI pPCI Registry (NCT04996901) enrolled 5586 STEMI patients undergoing pPCI from January 2015 to August 2021. Patients were divided into three groups after excluding those with hyperglycemia (ABG ≥11 mmol/L) and a history of diabetes. MACE was defined by re-infarction, stroke, and cardiovascular death. The association between ABG and in-hospital MACE was assessed using Logistic regression analysis. Results: 2890 non-diabetic STEMI patients with Killip class I treated with pPCI were identified. Patients were divided into three groups based on ABG (Q1: 2.5–5.72 mmol/L; Q2: 5.73–7.0 mmol/L; Q3: 7.01–11.0 mmol/L). After multivariate adjustment for age, gender, Diastolic Blood Pressure (DBP), Heart Rate (HR), smoking, and hypertension, the OR of MACE in Q2 and Q3 were 1.43–1.62 times of Q1 in the calibration Model II to IV. Subgroup analysis showed that the OR of Q2 was 3.52-fold of Q1 in females and 1.54-fold in the elder (≥60 years). Sensitivity analysis showed that after excluding patients with ABG less than 4 mmol/L, elevated ABG was still associated with a significant increase in the risk of MACE. The area under the ROC curve of ABG in predicting the occurrence of MACE after pPCI was 0.668, and the C-index was 0.666. The cubic spline confirmed MACE risk decreased significantly with ABG below 6.3 mmol/L. Conclusions: Elevated ABG is associated with increased risk of in-hospital MACE in non-diabetic STEMI patients treated with pPCI, particularly females and the elderly. This retrospective observational study was registered in Clinical Trials (NCT04996901).
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