Effect Of Acute-to-chronic Glycemic Ratio On Outcomes Of Patients With Acute Myocardial Infarction

Background: Abnormal glucose metabolism is an important cause of high morbidity and mortality of cardiovascular diseases.Acute myocardial infarction(AMI)is often accompanied by stress hyperglycemia,and the patients with stress hyperglycemia have a worse prognosis.Unlike a single blood glucose and glycosylated hemoglobin(Hb A1c),acute-to-chronic glycemic ratio adjusts stress glucose to baseline glucose to identify "true" stress hyperglycemia patients.However,there are few studies related to acute-to-chronic glycemic ratio and AMI.Objectives: To analyze the effect of acute-to-chronic glycemic ratio on in-hospital and2-year outcomes of patients with AMI.And to compare acute-to-chronic glycemic ratio,blood glucose and Hb A1 c in predicting the long-term(2-year)prognosis of patients with AMI.Methods: From January 2017 to December 2018,a total of 617 AMI patients who attended8 general hospitals were included in Chengdu.Data were collected from the hospital electronic case systems,and acute-to-chronic glycemic ratio was estimated based on admission blood glucose and Hb A1 c.AMI patients were divided into 4 groups according to the quartile of acute-to-chronic glycemic ratio [1.057(0.886,1.320)]: 154 cases in group A(<0.886),154 cases in group B(0.886-1.056),155 cases in group C(1.057-1.319),and 154 cases in group D(≥1.320),and the patients were followed up for 2 years by telephone or electronic case system.The baseline data,management strategies,acute heart failure in hospital,in-hospital all-cause mortality,and 2-year major adverse cardiovascular and cerebrovascular events(MACCE)were compared among the 4 groups of patients.Observation indicators:(1)Treatment-related indicators: the proportion of patients in each group receiving percutaneous coronary intervention(PCI)and the treatment time nodes of emergency PCI;(2)In-hospital prognostic indicators: all-cause mortality in hospital and the incidence of acute heart failure in hospital;(3)The prognostic indicator of the 2-year follow-up is the incidence of MACCE.The effect of acute-to-chronic glycemic ratio on all-cause death in AMI patients was analyzed by multivariate logistic regression analysis,and the impact of MACCE within 2 years of follow-up of AMI patients was analyzed by multivariate Cox regression analysis.And acute-to-chronic glycemic ratio,blood glucose and Hb A1 c were compared in predicting the long-term prognosis in AMI patients.Results:(1)The highest acute-to-chronic glycemic ratio group(group D)has the oldest patients,the highest proportion of female patients,the highest proportion of combined diabetes and hypertension,the highest proportion of Killip IV and multivessel disease(P<0.05).(2)In group D,the proportion of patients receiving PCI was the lowest(from group A to group D: 72.1% vs.81.2% vs.72.3% vs.64.9%,P=0.016).Among ST-segment elevation myocardial infarction patients who received emergency PCI,the differences of treatment time nodes of patients were not statistically significant in each group(P>0.05).(3)In group D,the incidence of in-hospital acute heart failure(from group A to group D: 17.9% vs.15.2% vs.18.4% vs.32.0%,P=0.001)and in-hospital all-cause mortality(from group A to group D: 3.2% vs.2.6 % vs.6.5% vs.13.6%,P <0.001)were the highest.Multivariate logistic regression analysis demonstrated that acute-to-chronic glycemic ratio was an independent influencing factor of all-cause death in hospital(P=0.024).Among them,group D with the highest acute-to-chronic glycemic ratio had the highest risk of all-cause death in hospital.The risks of group A,group B and group C were 0.236 times [95% CI(0.076-0.736),P=0.013],0.261 times [95%CI(0.082-0.832),P=0.023] and 0.544 times [95%CI(0.230-1.284),P=0.165] of group D,respectively.(4)In group D,the incidence of MACCE after 2 years of follow-up was also the highest(from group A to group D: 19.7% vs.8.2% vs.23.9% vs.43.2%,P<0.001).Multivariate Cox regression analysis demonstrated that acute-to-chronic glycemic ratio was an independent influencing factor of MACCE after2 years of follow-up(P<0.001).Among them,group D with the highest acute-to-chronic glycemic ratio had the highest risk of MACCE after 2 years of follow-up.The risks of group A,group B and group C were 0.498 times [95% CI(0.299-0.827),P=0.007],0.218 times[95%CI(0.108-0.440),P<0.001] and 0.615 times [95%CI(0.379-1.000),P=0.050] of group D,respectively.(5)ROC curve analysis demonstrated that area under the ROC curve(AUC) of acute-to-chronic glycemic ratio,admission blood glucose and Hb A1 c were 0.658,0.628,and 0.553,respectively.Conclusion: The group D with the highest acute-to-chronic glycemic ratio of AMI patients had the lowest proportion of receiving PCI.Acute-to-chronic glycemic ratio is an influencing factor for the in-hospital and long-term(2-year)prognosis of AMI patients.Compared with blood glucose and Hb A1 c,acute-to-chronic glycemic ratio has a better predictive value for MACCE during the 2-year follow-up period of AMI patients.