| Objective To evaluate the characteristic of glycemic fluctuations assessed by continuous glucose monitoring system (CGMS) in patients with acute myocardial infarction (AMI) with or without a history of diabetes mellitus (DM), and analyze the association of diabetes history and glycemic fluctuations with the outcome of these patients, and compare the prognostic value of the glycemic fluctuations and a history of DM in patients with AMI.Methods This is an observational study that involves105(including67male cases and38females cases) AMI patients collected continuously in Beijing Anzhen Hospital from September2009to June2010with onsets of symptom less than7days. Continuous glucose monitoring was performed over the patients with a glucose monitoring device. The parameters of dynamic glucose monitoring included:mean blood glucose of24hours (24hMBG) and standard deviation of blood glucose level (SDBG); mean amplitude of glycemic excursion (MAGE); absolute mean of daily difference (MODD); postprandial blood glucose excursion (PPGE); percentage of hyperglycemic time (PT7.8); percentage of hypoglycemic time (PT3.9). AMI patients were divided respectively into two groups according to the level of MAGE and with or without DM history. Patients were also followed up for12months for major adverse cardiac events (MACE). The prognostic value of blood glucose fluctuations and a history of DM in patients with AMI were compared.Results (1) We divided the cohort into two groups by a history of DM. The proportion of having a history of hypertension (92.5%vs55.8%, P<0.05) and stroke (24.5%vs3.8%, P<0.05)and Killip classification varied from Ⅱ to Ⅳ(15.1%vs3.8%, P<0.01) were higher in AMI patients with DM than patients without history. AMI patients with DM had higher levels in items of:fasting plasma glucose (8.34±2.87mmol/L vs5.89±1.62mmol/L, P<0.05), fasting plasma insulin (13.75±1.79μU/mL vs8.32±3.23μU/mL, P<0.05), glycosylated hemoglobin Alc (7.89±1.35%vs6.04±0.91%, P<0.05), microalbuminuria(72.24±185.12mg/L vs10.91±15.64mg/L, P<0.05) compared with their counterparts. Over an average12-month follow-up, AMI patients with DM had a higher occurrence of MACE(35.8%vs11.5%, P<0.01). Differences between two groups were significant.(2) AMI patients with DM have higher levels of24hMBG (9.33±2.00mmol/L vs6.72±1.51mmol/L, P<0.05), MAGE (3.64±1.47mmol/L vs2.23±1.16mmol/L, P<0.05), SDBG (2.40±0.99mmol/L vs1.41±0.67mmol/L, P<0.05), MODD (2.19±0.96mmol/L vs1.34±0.64mmol/L, P<0.05), PPGE (4.70±2.60mmol/L vs2.83±1.81mmol/L, P<0.05), and high percentage of PT7.8(63.12±28.22%vs21.95±22.55%, P<0.05)and PT3.9(5.05±11.91%vs2.80±5.79%, P<0.05). Differences between the two groups were significant.(3) The cohort was divided into two groups according to their MAGE levels of3.9mmol/L. The proportion of having a history of hypertension (79.6%vs55.8%, P<0.05), stroke (18.4%vs10.7%, P<0.05), DM(65.3%%vs37.5%, P<0.05) and Killip classification varied from Ⅱ to Ⅳ (14.3%vs5.4%, P<0.01) were higher in AMI patients with larger blood glucose excursions. The level of fasting plasma glucose (8.23±3.17mmol/L vs6.69±2.06mmol/L,P<0.05), serum creatinine (97.00±54.63μmol/L vs80.68±17.96μmol/L, P<0.05), glycosylated hemoglobin Alc (7.81±1.49%vs6.61±1.26%, P<0.05), microalbuminuria (82.58±204.18mg/L vs19.39±58.85mg/L, P<0.05) were also higher in these patients. Over an average12-month follow-up, AMI patients with larger blood glucose excursions had higher occurrence of MACE (40.8%vs8.9%, P< 0.01). Differences between the two groups were significant.(4) The cohort were divided into two groups:group1included53(50.5%) AMI patients with a history of DM, and the rest52(50.5%) patients, defined as group2, then each group were stratified into two subgroups according to their MAGE levels of3.9mmol/L. AMI patients having a history of DM with higher MAGE levels had higher occurrence of MACE compared to those with lower MAGE levels (50.0%vs14.3%, P<0.01). AMI patients in group2with higher MAGE levels had higher occurrence of MACE compared to those with lower MAGE levels (23.5%vs5.7%, P<0.05). Differences between the subgroups were significant.(5) Multiple regression analysis was made use of to show the impact factors of outcomes of patients with AMI. Without adding glucose variables in logistic regression analysis, we found that male, history of smoking and DM, Killip classification had the independent predictive values in the occurrence of MACE. However, when adding glucose variables, the independent predictive value of DM vanished, then the contributing factors were male, history of smoking, Killip classification, levels of glycosylated hemoglobin Alc and MAGE.Conclusion Larger glycemic fluctuations may be associated with more cardiovascular risk factors and target-organ damage, and may be associated with the occurrence of adverse cardiovascular events in12months. Those have severe fluctuations of blood glucose getting together with AMI tend to have worse clinical outcomes. This study suggests that we should pay much attention to glycemic fluctuations in patients with AMI regardless of a history of DM. |
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