Abstract 12989: Clinical Appearance of Glycemic Variability in Patients with ST-Elevated Myocardial Infarction Evaluated with Continuous Glucose Monitoring System (CGMS)
Background: previous studies demonstrated thatacute hyperglycemia on admission increases risk of cardiac events after ST-elevated myocardial infarction (STEMI) patients who underwent coronary interventions. However, it still remains unclear whether acute glycemic variability has the important prognostic significance in STEMI patients.
Therefore, this study aimed to evaluate the relationship between cardiac events and the variability of glucose levels by a continuous glucose monitoring system (CGMS).
Methods: This prospective study enrolled 40 patients (Mean age was 70±14 years, male was 78 %) with STEMI. All patients were inserted CGMS on admission and were measured at least 48-hours. CGMS provide with glycemic excursion displayed at 5-minutes intervals, 576 points during 48 hours. Primary end points were the incidence of major adverse cardiac events (MACE) at 1 year, including cardiac death, myocardial infarction, and heart failure.
Results: We found 3 patterns regarding to the change of glucose wave (figure).
The three patterns were defined persistent hyperglycemic pattern (PHP), intermittent hyperglycemic pattern (IHP), normal glycemic pattern (NGP).
Significant differences were observed regarding the mean amplitude of glycemic excursions among 3 patterns (120±61mg/dl, 93±41mg/dl, and 45±16mg/dl in PHP, IHP, and NGP, respectively p=0.0004). The MACE incidence rates were 75%, 31%, and 5% in PHP, IHP, and NGP, respectively, (p=0.17). Although there was no significant difference in cardiac death among 3-pattern, the rate of new-onset heart failure was significantly higher with increasing glycemic impairment. (75%, 12%, and 5%,respectively p=0.18)
Conclusion: A significant relationship was observed between cardiac events and the variability of hyperglycemic levels during 48 hours after coronary interventions. Patients with PHP, even IHP, were associated with an increased risk of cardiac events.
- © 2013 by American Heart Association, Inc.