Predictive value of glycemic gap for myocardial ischemia reperfusion injury in non-diabetic patients with acute ST-segment elevation myocardial infarction

doi:10.3877/cma.j.issn.1674-6880.2021.06.002

Abstract

Abstract:

Objective

To investigate the predictive value of glycemic gap for myocardial ischemia reperfusion injury (MIRI) in non-diabetic patients with acute ST-segment elevation myocardial infarction (STEMI).

Methods

A total of 541 non-diabetic patients with STEMI admitted to Beijing Anzhen Hospotal, Capital Medical University from January to December 2019 were selected. The age, male, smoking, time of onset, multiple lesions, admission blood glucose (ABG), glycosylated hemoglobin, glycemic gap, blood creatinine, urea nitrogen, triglyceride, total cholesterol, hypersensitive C-reactive protein (hs-CRP) peak and cardiac troponin I (cTNI) peak were included in univariate Logistic regression analysis to screen out relevant influencing factors, and then included in multivariate Logistic regression analysis to obtain independent risk factors affecting MIRI in non-diabetic STEMI patients. The receiver operating characteristic (ROC) curve was used to analyze the predictive value.

Results

Six factors were associated with MIRI in non-diabetic STEMI patients by univariate Logistic regression analysis, including ABG [odds ratio (OR) = 1.149, 95% confidence interval (CI) (1.037, 1.273), P = 0.008], glycemic gap [OR = 1.267, 95%CI (1.121, 1.432), P < 0.001], urea nitrogen [OR = 1.153, 95%CI (1.020, 1.304), P = 0.023], total cholesterol [OR = 0.791, 95%CI (0.645, 0.971), P = 0.025], hs-CRP peak [OR = 1.016, 95%CI (1.006, 1.026), P = 0.002] and cTNI peak [OR = 1.010, 95%CI (1.003, 1.017), P = 0.008]. Multivariate Logistic regression analysis showed that glycemic gap [OR = 1.537, 95%CI (1.140, 2.074), P = 0.005] and hs-CRP peak [OR = 0.659, 95%CI (1.004, 1.024), P = 0.007] were independent risk factors for MIRI in non-diabetic STEMI patients. ROC curve analysis showed that glycemic gap [area under the curve = 0.609, 95%CI (0.547, 0.672), P = 0.001] had certain predictive value for the occurrence of MIRI in non-diabetic STEMI patients.

Conclusion

Glycemic gap is an independent risk factor for MIRI in non-diabetic STEMI patients and has predictive value for MIRI.

Key words: Myocardial ischemia-reperfusion injury, Glycemic gap, Acute ST-segment elevation myocardial infarction, Stress-induced hyperglycemia, Risk factors

Shuying Qi, Xiang Li, Fei Liu. Predictive value of glycemic gap for myocardial ischemia reperfusion injury in non-diabetic patients with acute ST-segment elevation myocardial infarction[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2021, 14(06): 448-452.

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References 29

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变量	回归系数	标准误	Wald值	P值	OR值	95%CI
男性	0.443	0.286	2.407	0.121	1.557	0.890 ~ 2.725
年龄（岁）	0.008	0.010	0.649	0.420	1.008	0.989 ~ 1.027
吸烟	-0.021	0.230	0.009	0.927	0.979	0.624 ~ 1.535
发病时间（h）	-0.036	0.023	2.440	0.118	0.965	0.923 ~ 1.009
多支病变	-0.451	0.230	3.829	0.050	0.637	0.406 ~ 1.001
ABG（mmol / L）	0.139	0.052	7.027	0.008	1.149	1.037 ~ 1.273
HbA1c（mmol / L）	-0.243	0.190	1.635	0.201	0.784	0.541 ~ 1.138
血糖间隙（mmol / L）	0.237	0.063	14.315	< 0.001	1.267	1.121 ~ 1.432
血肌酐（μmol / L）	0.007	0.006	1.429	0.232	1.007	0.996 ~ 1.018
尿素氮（mmol / L）	0.142	0.063	5.183	0.023	1.153	1.020 ~ 1.304
甘油三酯（mmol / L）	-0.250	0.128	3.796	0.051	0.779	0.606 ~ 1.001
总胆固醇（mmol / L）	-0.234	0.104	5.043	0.025	0.791	0.645 ~ 0.971
hs-CRP峰值（mg / L）	0.016	0.005	9.478	0.002	1.016	1.006 ~ 1.026
cTNI峰值（μg / L）	0.010	0.004	7.019	0.008	1.010	1.003 ~ 1.017

变量	回归系数	标准误	Wald值	P值	OR值	95%CI
男性	0.443	0.286	2.407	0.121	1.557	0.890 ~ 2.725
年龄（岁）	0.008	0.010	0.649	0.420	1.008	0.989 ~ 1.027
吸烟	-0.021	0.230	0.009	0.927	0.979	0.624 ~ 1.535
发病时间（h）	-0.036	0.023	2.440	0.118	0.965	0.923 ~ 1.009
多支病变	-0.451	0.230	3.829	0.050	0.637	0.406 ~ 1.001
ABG（mmol / L）	0.139	0.052	7.027	0.008	1.149	1.037 ~ 1.273
HbA1c（mmol / L）	-0.243	0.190	1.635	0.201	0.784	0.541 ~ 1.138
血糖间隙（mmol / L）	0.237	0.063	14.315	< 0.001	1.267	1.121 ~ 1.432
血肌酐（μmol / L）	0.007	0.006	1.429	0.232	1.007	0.996 ~ 1.018
尿素氮（mmol / L）	0.142	0.063	5.183	0.023	1.153	1.020 ~ 1.304
甘油三酯（mmol / L）	-0.250	0.128	3.796	0.051	0.779	0.606 ~ 1.001
总胆固醇（mmol / L）	-0.234	0.104	5.043	0.025	0.791	0.645 ~ 0.971
hs-CRP峰值（mg / L）	0.016	0.005	9.478	0.002	1.016	1.006 ~ 1.026
cTNI峰值（μg / L）	0.010	0.004	7.019	0.008	1.010	1.003 ~ 1.017

变量	回归系数	标准误	Wald值	P值	OR值	95%CI
ABG（mmol / L）	-0.278	0.140	3.973	0.051	0.757	0.576 ~ 0.995
血糖间隙（mmol / L）	0.430	0.153	7.925	0.005	1.537	1.140 ~ 2.074
尿素氮（mmol / L）	0.091	0.055	2.719	0.099	1.095	0.983 ~ 1.220
总胆固醇（mmol / L）	-0.202	0.110	3.392	0.066	0.983	0.659 ~ 1.013
hs-CRP峰值（mg / L）	0.014	0.005	7.396	0.007	0.659	1.004 ~ 1.024
cTNI峰值（μg / L）	0.005	0.004	1.992	0.158	1.004	0.998 ~ 1.014

变量	回归系数	标准误	Wald值	P值	OR值	95%CI
ABG（mmol / L）	-0.278	0.140	3.973	0.051	0.757	0.576 ~ 0.995
血糖间隙（mmol / L）	0.430	0.153	7.925	0.005	1.537	1.140 ~ 2.074
尿素氮（mmol / L）	0.091	0.055	2.719	0.099	1.095	0.983 ~ 1.220
总胆固醇（mmol / L）	-0.202	0.110	3.392	0.066	0.983	0.659 ~ 1.013
hs-CRP峰值（mg / L）	0.014	0.005	7.396	0.007	0.659	1.004 ~ 1.024
cTNI峰值（μg / L）	0.005	0.004	1.992	0.158	1.004	0.998 ~ 1.014

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