Evaluation Of Short-term Prognosis In Patients With Type 2 Diabetes Mellitus Complicated With Acute Myocardial Infarction By Fasting Plasma Glucose And Single-Day Insulin Dose Combined With GRACE Score

Objective: To explore independent predictors of short-term prognosis in type 2diabetes mellitus(T2DM)patients with acute myocardial infarction(AMI).Fasting plasma glucose(FPG),single-day insulin dose,and GRACE score were combined to evaluate the short-term prognosis of T2 DM patients with AMI.Methods: We selected 347 T2 DM patients with AMI who were hospitalized in the cardiovascular department from July 2013 to July 2018.The clinical data of the patients were collected,including general condition,past history,vital signs,insulin dosage and other treatment history.Troponin I(Tn I),myoglobin(Myo),creatine kinase isoenzyme(CK-MB),blood glucose and electrocardiogram were measured immediately after admission.FPG,serum creatinine(SCr),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C)were measured on an empty stomach in the next morning.We used the GRACE score table to calculate the GRACE score.SPSS 24.0 and R 3.6.1software were used for statistical analysis.Independent sample T test,Mann-Whitney U test,chi-square test,one-way ANOVA and KruskalWallis test were used in the comparison between groups.The correlation between GRACE score and each variable was analyzed.Multiple linear regression and logistic regression were used for regression analysis.P<0.05 was considered to be statistically significant.Results:1.Patients were divided into the death group(n=25)and the survival group(n=322)according to whether they died during hospitalization.Compared with the survival group,the death group had higher age(71.24±7.43 vs 67.72±10.93),admission blood glucose(15.31±3.91 vs 13.60±4.74),FPG(17.25±3.55 vs12.54±4.66),single-day insulin dose(37.36±8.00 vs 30.63±10.89),Myo(279.15(124.16,509.28)vs 70.06(20.00,246.70)),and GRACE score(178.96±28.07 vs 154.66±29.49),lower height(1.62±0.78 vs 1.67±0.74),systolic pressure(116.64±29.30 vs 136.02±24.96),and diastolic pressure(68.40±17.63 vs79.78±14.23).The difference was statistically significant(P<0.05).2.The correlation analysis between GRACE score and various variables showed that the GRACE score was positively correlated with age(r=0.660),heart rate(r=0.288),admission blood glucose(r=0.798),FPG(r=0.775),daily insulin dose(r=0.943),and Tn I(r=0.178)(P < 0.05).The GRACE score was negatively correlated with body weight(r=-0.197),BMI(r=-0.185),systolic blood pressure(r=-0.296),diastolic blood pressure(r=-0.283),TG(r=-0.208),hyperlipidemia(r=-0.165),and smoking history(r=-0.144)(P<0.05).3.The patients were divided into low-risk group(n=17),medium-risk group(n=80),and high-risk group(n=250)according to the GRACE risk scoring standard.There were significant differences in age(53.29±10.45 vs 59.44±9.52 vs 71.71±8.52),admission blood glucose(7.93±1.88 vs 9.60±2.12 vs 15.43±4.28),FPG(6.97±1.71 vs 8.99±2.64 vs 14.53±4.35),single-day insulin dose(9.00±1.41 vs15.48±5.15 vs 35.03 ± 7.86),TG(2.21(1.17,2.68)vs 1.80(1.20,2.59)vs 1.34(1.04,1.87)),Tn I(2.21(1.17,2.68)vs 1.80(1.20,2.59)vs 1.34(1.04,1.87)),hyperlipidemia(2.21(1.17,2.68)vs 1.80(1.20,2.59)vs 1.34(1.04,1.87)),and smoking history(9(7.0%)vs 37(28.9%)vs 82(64.1%))among the three groups and between the two groups(P < 0.05).The heart rate(71.24±15.39 vs 79.23±12.67 vs 83.02±19.53,P=0.014)was significantly different among the three groups.There was significant difference between the two groups only between the low-risk group and the high-risk group(P=0.009).The systolic blood pressure(150.24±24.65 vs 143.45±25.15 vs 130.74±24.98,P<0.001)and diastolic blood pressure(85.29±9.79 vs 85.46±14.97 vs 76.44±14.25,P<0.001)was significantly different among the three groups.There were significant differences between the two groups only between low-risk group and high-risk group,middle-risk group and high-risk group(P <0.05).4.We used GRACE score as the dependent variable,age,heart rate,systolic blood pressure,diastolic blood pressure,admission blood glucose,FPG,single-dayinsulin dose,TG,Tn I,hyperlipidemia,and smoking history as independent variables for multiple linear regression analysis.We found that only FPG and single-day insulin dose had a linear relationship with GRACE score(P<0.001),and the regression equation was statistically significant(P<0.001).The effect of single-day insulin dose(Beta=0.695)and FPG(Beta=0.210)on GRACE score decreased in turn.5.We used death during hospitalization as the dependent variable,FPG,singleday insulin dose,and GRACE score as independent variables for logistic regression analysis.The GRACE score,FPG,and single-day insulin dose were independent predictors of death risk in T2 DM patients with AMI during hospitalization(P <0.05).6.The ROC curve was drawn between GRACE score,FPG,and single-day insulin dose.The AUC of GRACE score,FPG,single-day insulin dose,GRACE score+FPG,GRACE score+single-day insulin dose,FPG+single-day insulin dose,and GRACE score+FPG+single-day insulin were 0.603,0.743,0.677,0.743,0.786,0.767,and 0.813,respectively.The AUC of the three combined predictors was the largest.7.According to the cut-off point corresponding to the maximum value of the Youden index,the best cut-off values of GRACE score,FPG and single-day insulin dose was 167,11.94mmol/L,and 28U/d,respectively.The best cut-off value of the new combined prediction factor was 0.117.Conclusion: FPG,single-day insulin dose,and GRACE score were independent predictors of short-term death during hospitalization in T2 DM patients with AMI.The combination of FPG,single-day insulin dose,and GRACE score to build a new model can improve the ability of the original GRACE score to predict the short-term prognosis of patients.