An Elevated Glycemic Gap is Associated with Adverse Outcomes in Diabetic Patients with Acute Myocardial Infarction.
An Elevated Glycemic Gap is Associated with Adverse Outcomes in Diabetic Patients with Acute Myocardial Infarction.
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DOI：
10.1038/srep27770
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发表时间：
2016-06-13
影响因子：
4.6
通讯作者：
Tsai SH
中科院分区：
文献类型：
--
作者：
Liao WI;Lin CS;Lee CH;Wu YC;Chang WC;Hsu CW;Wang JC;Tsai SH
急性高血糖症是急性心肌梗塞（AMI）急诊科（艾德）常见的并发症。高血糖在糖尿病合并AMI患者中的预后作用仍有争议。我们回顾性分析了患者的病历，以获得人口统计学数据、临床表现、主要不良心脏事件（MACE）、几种临床评分和实验室数据，包括初始表现时的血糖水平和HbA1c水平。根据艾德入院时的血糖水平减去HbA1 c衍生的平均血糖（ADAG）计算血糖间隙，代表索引事件期间血清葡萄糖水平的变化。在审查病历后，我们招募了331名患者。入院时血糖水平和ADAG之间的血糖差距升高与患者死亡风险增加相关。与入院时的血糖水平相比，血糖差距显示出对MACE发展的上级鉴别力。血糖间隙的计算可能会增加已建立的临床评分系统在因AMI就诊于艾德的糖尿病患者中的辨别力。结论：血糖间隙可作为评估糖尿病合并急性心肌梗死患者病情严重程度及预后的辅助指标。然而，血糖间隙的有用性应在前瞻性纵向研究中进一步探讨。
Acute hyperglycemia is a frequent finding in patients presenting to the emergency department (ED) with acute myocardial infarction (AMI). The prognostic role of hyperglycemia in diabetic patients with AMI remains controversial. We retrospectively reviewed patients’ medical records to obtain demographic data, clinical presentation, major adverse cardiac events (MACEs), several clinical scores and laboratory data, including the plasma glucose level at initial presentation and HbA1c levels. The glycemic gap, which represents changes in serum glucose levels during the index event, was calculated from the glucose level upon ED admission minus the HbA1c-derived average glucose (ADAG). We enrolled 331 patients after the review of medical records. An elevated glycemic gap between admission serum glucose levels and ADAG were associated with an increased risk of mortality in patients. The glycemic gap showed superior discriminative power regarding the development of MACEs when compared with the admission glucose level. The calculation of the glycemic gap may increase the discriminative powers of established clinical scoring systems in diabetic patients presenting to the ED with AMI. In conclusion, the glycemic gap could be used as an adjunct parameter to assess the severity and prognosis of diabetic patients presenting with AMI. However, the usefulness of the glycemic gap should be further explored in prospective longitudinal studies.