The Effect Of Stress Hyperglycemia On The Clinical Prognosis Of Patients With Acute Myocardial Infarction Undergoing Successful Percutaneous Coronary Intervention

Objective:To observe the occurrence of major adverse cardiovascular events?MACE?in patients with acute myocardial infarction?AMI?undergoing successful percutaneous coronary intervention?PCI?during hospitalization and 1 year after discharge.To explore the effect of stress hyperglycemia?SHG?on the clinical prognosis of AMI patients undergoing successful PCI.Methods:A retrospective analysis was performed on 421 non-diabetic patients who had the first AMI and received successful PCI in our hospital from May 2010 to July 2016.According to the fasting blood glucose at first admission,the patients were divided into two groups:no SHG group?blood glucose<7.0 mmol/L,n=344?and SHG group?blood glucose?7.0mmol/L,n=77?.The basic clinical data,laboratory examination and coronary angiography?CAG?results of patients were analyzed by consulting the inpatient medical records and the original database.The evaluation of clinical risk stratification with GRACE score.The severity of coronary artery lesions was evaluated by Gensini score.Compared the MACE during hospitalization:all-cause mortality,heart failure,malignant arrhythmia and the number of composite outcomes events in both groups,the patients were followed up by outpatient follow-up,readmission medical records and telephone follow-up for 1 year MACE:all-cause mortality,heart failure,non-fatal myocardial infarction and the number of composite outcomes events.The basic baseline data of the two groups were compared by independent sample T-test and chi-square test,and the independent risk factors of all-cause mortality during hospitalization were evaluated by multivariate Cox proportional risk regression model.Pearson correlation analysis was used to test the correlation between fasting blood glucose and GRACE score in SHG group,the receiver operating characteristic?ROC?was compared to predict the value of fasting blood glucose,GRACE score and Gensini score in patients with SHG during hospitalization.Results:The probability of occurrence of SHG is 18.3%?77/421?.The patients of STEMI,emergency PCI,history of hypertension,triglyceride?TG?,total cholesterol?TC?,high density lipoprotein cholesterol?HDL-C?,low density lipoprotein cholesterol?LDL-C?,creatinine and Gensini score have no difference in the two groups?p>0.05?.In SHG group,the proportion of female patients?36.4%vs 19.5%,p=0.002?,Killip II-IV?35.1%vs 25.4%,p<0.001?,age[?66.60±12.23?vs?63.26±12.19?,p=0.031],fasting blood glucose[?9.31±2.73?vs?5.34±0.79?,p<0.001],the White blood cell?WBC?[?10.53±5.10?vs?8.76±2.95?,p=0.004],GRACE score[?154.39±36.31?vs?135.52±34.09?,p<0.001]was significantly higher than that of no SHG group.In the SHG group,all-cause mortality?11.7%vs 1.5%,p<0.001?,heart failure?40.3%vs19.5%,p<0.001?,the malignant arrhythmia?13%vs 2.6%,p=0.001?and the number of composite outcomes events?42.9%vs 20.3%,p<0.001?was higher than that of no SHG group.The results of multivariate Cox regression analysis showed that SHG was an independent risk factor for all-cause mortality of AMI patients undergoing successful PCI during hospitalization?OR=3.483,95%CI:1.033¹1.744,p=0.044?.There was no difference in all-cause mortality?1.3%vs 1.7%,p=0.624?,heart failure?13.0%vs 7.0%,p=0.070?,nonfatal myocardial infarction?0.0%vs 2.3%,p=0.196?and the number of composite outcomes events?15.6%vs 12.8%,p=0.312?within 1 year after discharge between the two groups.In the subgroup study of SHG patients,there was a positive correlation between fasting blood glucose concentration and GRACE score,and all-cause mortality,heart failure and the number of composite outcomes events increased with the increase of fasting blood glucose during hospitalization.Fasting blood glucose,GRACE score and Gensini score for the area under ROC curve to predicte the MACE during hospitalization in SHG group:1)Prediction of all-cause mortality:AUC _{blood glucose}=0.851?95%CI:0.720⁰.982,p=0.001?,AUC _{GRACE score}=0.869?95%CI:0.763⁰.975,p<0.001?,AUC _{Gensini score}=0.761?95%CI:0.600⁰.921,p=0.011?,the Z test results showed that there was no difference in the predictive value of all-cause mortality among the three groups during hospitalization?p>0.05?.2)Prediction of heart failure:AUC_{blood glucose}=0.711?95%CI:0.594⁰.827,p=0.002?,AUC_{GRACE score}=0.918?95%CI:0.861⁰.976,p<0.001?,AUC_{Gensini score}=0.658?95%CI:0.531⁰.785,p=0.019?,the Z test results showed that the predictive value of GRACE score for heart failure was higher than that of fasting blood glucose and Gensini score?p<0.05?.3)prediction of malignant arrhythmia:AUC_{blood glucose}=0.588?95%CI:0.410⁰.766,p=0.371?,AUC_{GRACE score}=0.762?95%CI:0.649⁰.875,p=0.008?,AUC_{Gensini score}=0.723?95%CI:0.536⁰.911,p=0.023?,fasting blood glucose has no predictive value for malignant arrhythmia,The Z test showed that there was no difference between GRACE score and Gensini score in predicting the incidence of malignant arrhythmia during hospitalization?p>0.05?.4)the prediction of the number of composite outcomes events:AUC_{blood glucose}=0.695?95%CI:0.578⁰.811,p=0.004?,AUC_{GRACE score}=0.928?95%CI:0.874⁰.981,p<0.001?,AUC _{Gensini score}=0.655?95%CI:0.530⁰.779,p=0.021?,the Z test showed that GRACE score was superior to Gensini score in predicting the number of composite outcomes events during hospitalization?p<0.05?,there was no difference in fasting blood glucose between the two groups?p>0.05?.Conclusion:1.SHG increased the incidence of MACE in AMI patients undergoing successful PCI during hospitalization,and SHG is an independent risk factor for all-cause mortality.2.Fasting blood glucose of SHG plays an important role in the risk of the occurrence of MACE during hospitalization in AMI patients undergoing successful PCI,and is a predictor of the severity of the disease.3.The severity of coronary lesion did not increase the incidence of SHG.4.There was no correlation between SHG and 1 year clinical prognosis in AMI patients undergoing successful PCI.