Abstract 13295: Clinical Significance of Blood Glucose Variability Pattern in the Acute Phase of ST-segment Myocardial Infarction (STEMI)
Background: Hyperglycemia on admission is an important predictor of outcomes in patients with STEMI, but its optimal management remains unclear. Recently, glycemic variability has received considerable attention as a new risk factor for dysglycemia. The aim of the study was to investigate glucose variability in the acute phase of STEMI and to evaluate the clinical significance of such variability.
Methods: In this prospective observational study, we enrolled 66 STEMI patients with successful reperfusion within 12 hours after the onset. All patients wore a continuous glucose monitoring system in a fasting state within 24 hours after admission to the coronary care unit. We assessed individual glucose variability patterns and compared the relations of such patterns to clinical characteristics with blood glucose levels on admission and HbA1c levels. Glucose variability was determined by calculating the mean amplitude of glycemic excursions (MAGE).
Results: Despite the fasting state, a variety of blood glucose variability patterns were observed in the acute phase of STEMI (Figure 1). Although glucose-lowering therapy was withheld, 12.3% of the patients had hypoglycemia (blood glucose level <70 mg/dL). In 30 patients with anterior STEMI, the peak CK-MB level positively correlated with MAGE as an indicator of glucose variability (r=0.49, p<0.01), but not with blood glucose levels on admission (r=0.28, p=0.14) or HbA1c levels (r=0.19, p=0.33) (Figure 2). In addition, MAGE positively correlated with neutrophils on admission (r=0.42, p<0.05) as well as the plasma norepinephrine level (r=0.44, p<0.05), while the other glucose parameters did not.
Conclusion: In the acute phase of STEMI patients with successful reperfusion, a variety of blood glucose variability patterns were observed. Higher glucose variability more strongly correlated with larger infarct size than did the blood glucose level on admission, and HbA1c level in patients with anterior STEMI.
- © 2013 by American Heart Association, Inc.