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Frontiers of Medicine

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ISSN 2095-0225(Online)

CN 11-5983/R

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Front. Med.    2021, Vol. 15 Issue (1) : 70-78    https://doi.org/10.1007/s11684-020-0749-x
RESEARCH ARTICLE
Prognostic value of fasting glucose on the risk of heart failure and left ventricular systolic dysfunction in non-diabetic patients with ST-segment elevation myocardial infarction
Hui Wang, Yang Zhang, Zhujun Shen, Ligang Fang, Zhenyu Liu(), Shuyang Zhang()
Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Abstract

Recent studies have shown that acute blood glucose elevation in patients with ST-segment elevation myocardial infarction (STEMI) suggests a poor prognosis. To investigate the effect of fasting blood glucose (FBG) on the risk of heart failure (HF) and left ventricular systolic dysfunction (LVSD) in non-diabetic patients undergoing primary percutaneous coronary intervention (PCI) for acute STEMI, we retrospectively recruited consecutive non-diabetic patients who underwent primary PCI for STEMI in our hospital from February 2003 to March 2015. The patients were divided into two groups according to the FBG level. A total of 623 patients were recruited with an age of 61.3±12.9 years, of whom 514 (82.5%) were male. The HF risk (odds ratio 3.401, 95% confidence interval (CI) 2.144–5.395, P <0.001) was significantly increased in patients with elevated FBG than those with normal FBG. Elevated FBG was also independently related to LVSD (β 1.513, 95%CI 1.282–1.785, P <0.001) in a multiple logistics regression analysis. In conclusion, elevated FBG was independently associated with 30-day HF and LVSD risk in non-diabetic patients undergoing primary PCI for STEMI.
Keywords myocardial infarction      percutaneous coronary intervention      diabetes mellitus      fasting glucose      heart failure     
Corresponding Author(s): Zhenyu Liu,Shuyang Zhang   
Just Accepted Date: 28 March 2020   Online First Date: 10 June 2020    Issue Date: 11 February 2021
 Cite this article:   
Hui Wang,Yang Zhang,Zhujun Shen, et al. Prognostic value of fasting glucose on the risk of heart failure and left ventricular systolic dysfunction in non-diabetic patients with ST-segment elevation myocardial infarction[J]. Front. Med., 2021, 15(1): 70-78.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-020-0749-x
https://academic.hep.com.cn/fmd/EN/Y2021/V15/I1/70
Normal FBG group
(n = 462)		 Elevated FBG group
(n = 161)		 P value
Demographic characteristics
Age (year) 61.5±12.8 60.8±13.2 0.535
Gender (male %) 383 (82.9) 131 (81.4) 0.718
BMI (kg/m2) 24.8±3.5 25.0±3.8 0.568
Risk factors of CAD (n (%))
Hypertension 253 (54.8) 100 (62.1) 0.117
Hyperlipidemia 206 (44.6) 68 (42.2) 0.645
Smoking 293 (63.4) 101 (62.7) 0.924
Premature CAD family history 98 (21.2) 34 (21.1) 1.000
Complications and previous history of CAD (n (%))
CKD 15 (3.2) 9 (5.6) 0.232
Stroke 42 (9.1) 15 (9.3) 1.000
Previous MI 26 (5.6) 8 (5.0) 0.843
Coronary revascularization 25 (5.4) 6 (3.7) 0.529
Clinical features
Symptom-to-door time (h) 2.5 (1.5, 5.0) 3.0 (1.5, 5.4) 0.495
Admission HR (time/min) 80.7±17.0 86.1±17.2 0.001
Admission SBP (mmHg) 116.8±19.9 117.5±22.4 0.724
Anterior MI (n (%)) 243 (52.6) 96 (59.6) 0.141
Laboratory examination
Admission Hb (g/ L) 141.7±18.6 145.1±23.8 0.180
eGFR (mL/min) 75.3 (64.8, 88.1) 80.0 (66.5, 96.8) 0.034
LDL-C (mmol/L) 2.9 (2.4, 3.5) 2.9 (2.3, 3.4) 0.136
WBC (109/L) 9.6 (7.7, 11.6) 10.4 (8.2, 13.8) 0.017
hsCRP (mg/L) 6.5 (2.0, 12.0) 7.4 (4.8, 15.0) 0.003
HbA1c (%) 5.7 (5.4, 6.0) 5.8 (5.6, 6.2) 0.097
Coronary arteriography
Symptom-to- balloon time (h) 5.0 (3.0, 7.7) 5.0 (3.5, 8.8) 0.178
LAD as the culprit vessel (n (%)) 233 (50.4) 88 (54.7) 0.362
Multi-vessel lesion (n (%)) 349 (75.5) 117 (72.7) 0.463
Triple vessel lesion (n (%)) 205 (44.4) 62 (38.5) 0.229
TIMI 0 in preoperative (n (%)) 326 (70.6) 120 (74.5) 0.362
TIMI 3 in postoperative (n (%)) 34 (7.4) 12 (7.5) 1.000
Successful PCI (n (%)) 432 (93.5) 156 (96.9) 0.116
IABP application (n (%)) 10 (2.2) 7 (4.3) 0.161
Drug therapy (n (%))
GPIIb/IIIa receptor antagonist 181 (39.2) 66 (41.0) 0.709
β-receptor blocker 414 (89.6) 140 (87.0) 0.382
ACEI/ARB 400 (86.6) 130 (80.7) 0.094
Statin 439 (95.0) 158 (98.1) 0.109
Tab.1  Baseline characteristics of normal FBG group and elevated FBG group
Fig.1  Kaplan–Meier estimates of freedom from heart failure. The risk of 30-day HF was significantly increased in patients in the elevated FBG group compared with those in the normal FBG group, P<0.001. HF, heart failure; FBG, fasting blood glucose.
Normal FBG group
(n = 462)		 Elevated FBG group
(n = 161)		 P value
HF (n (%)) 46 (10.0) 44 (27.3) <0.001
NT-proBNP (pg/mL) 420.0 (200.0, 1400.0) 1380.0 (337.3, 4206.8) <0.001
CK-MB peak (ng/mL) 183.3 (94.3, 381.1) 334.9 (130.4, 587.4) <0.001
cTnI peak (ng/mL) 70.8 (32.5, 149.7) 116.2 (50.2, 204.6) <0.001
LVEDD (mm) 49.4±4.2 52.3±5.8 <0.001
LVEF (%) 59.1±10.0 51.4±12.0 <0.001
Recurrent MI (n (%)) 7 (1.5) 1 (0.6) 0.687
Cardiac shock (n (%)) 19 (4.1) 15 (9.3) 0.016
Malignant arrhythmia (n (%)) 34 (7.4) 29 (18.0) <0.001
Cardiac mechanical complication (n (%)) 19 (4.1) 13 (8.2) 0.044
Cardiac death (n (%)) 5 (1.1) 7 (4.3) 0.009
CI-AKI (n (%)) 28 (6.1) 24 (14.9) 0.001
All-cause mortality (n (%)) 5 (1.1) 9 (5.6) 0.001
Tab.2  Comparison of HF, MI complications, and prognosis in different FBG groups at 30 days
HR (95% CI) P value HR (95% CI) P value
Age 1.038 (1.020−1.056) <0.001 1.032 (1.011−1.052) 0.002
Hypertension 1.210 (0.792–1.848) 0.379 1.004 (0.646–1.560) 0.986
Previous MI 2.954 (1.608–5.429) <0.001 2.990 (1.585–5.639) 0.001
FBG 1.308 (1.213–1.411) <0.001 1.273 (1.168–1.388) <0.001
eGFR 0.984 (0.975–0.994) 0.001 0.993 (0.982–1.005) 0.244
Symptom-to-balloon time 1.012 (0.975–1.049) 0.542 1.006 (0.966–1.046) 0.787
LAD as the culprit vessel 2.416 (1.531–3.812) <0.001 2.261 (1.422–3.595) 0.001
β-receptor blocker 1.498 (0.692–3.239) 0.305 1.373 (0.629–2.997) 0.426
ACEI/ARB 0.524 (0.324–0.848) 0.008 0.730 (0.425–1.253) 0.253
Tab.3  Independent association of risk of HF within 30 days of the patient
Fig.2  Comparison of left ventricular size and systolic function in different FBG groups. Left ventricular end-diastolic diameter (LVEDD) was significantly increased (52.3±5.8 mm vs. 49.4±4.2 mm, P<0.001), and left ventricular ejection fraction (LVEF) was significantly decreased (51.4%±12.0% vs. 59.1%±10.05%, P<0.001) in patients in the elevated FBG group compared with those in the normal FBG group. FBG, fasting blood glucose.
β (95% CI) P value β (95% CI) P value
Age 1.011 (0.989–1.034) 0.326 1.006 (0.980–1.034) 0.649
FBG 1.541 (1.320–1.799) <0.001 1.513 (1.282–1.785) <0.001
eGFR 0.996 (0.985–1.008) 0.532 0.997 (0.984–1.011) 0.692
Symptom-to-balloon time 1.068 (1.025–1.113) 0.002 1.080 (1.030–1.131) 0.001
LAD as the culprit vessel 4.517 (2.226–9.163) <0.001 4.493 (2.152–9.384) <0.001
Tab.4  Independent association of left ventricular systolic dysfunction
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