| Background Acute myocardial infarction(AMI)is a serious cardiovascular disease that causes death and disability,and its morbidity and mortality are still showing a rapid increase trend.Diabetes mellitus(DM)is an important risk factor for recurrent myocardial infarction and all-cause death in patients with acute myocardial infarction,stress hyperglycemia during AMI is also closely associated with poor prognosis,and this relationship may be more significant in AMI patients without diabetes mellitus.Current studies have found that admission blood glucose(blood glucose under stress,SH),SHR,and HbA1c are related to the poor prognosis of AMI patients,but their predictive value is still controversial.In this study,we compared the predictive value of three blood glucose indexes for recurrence of adverse cardiovascular events(MACE)14 days and 6 months after admission in patients with AMI,hoping to provide certain guiding significance for the identification of high-risk patients with AMI.Methods A retrospective analysis was performed on 284 patients with acute myocardial infarction initially diagnosed in the Department of Cardiovascular Medicine of Yichang Central People’s Hospital from December 2018 to April 2022.Admission blood glucose,HbAlc,basic information,clinical data,14-day and 6-month MACE events were recorded.SHR=SH/[(1.59×HbA1c)-2.59].Patients were divided into AMI with DM group(n=105)and AMI without DM group(n=179)according to whether they had diabetes.They were further divided into high and low groups according to the cut-off admission blood glucose,HbAlc and SHR,and into event group and non-event group according to the occurrence of MACE events.Differences between groups were compared,and SPSS26.0 statistical software was used for processing.P<0.05 was considered statistically significant.Results1.Regardless of diabetes mellitus or not,the incidence of 14-day MACE was higher in the high SH group than in the low SH group;The high SHR group also had a higher 14-day incidence of MACE than the low SHR group.2.Binary Logistic regression analysis was performed on AMI patients with DM,and the results showed that HbA1c(OR:1.471,P<0.05),SHR(OR:6.711,P<0.05),SH(OR:1.182,P<0.05)were independent risk factors for prognosis of AMI patients(after adjusting for confounding factors);Binary Logistic regression analysis for AMI patients without DM showed that SHR(OR:4.992,P<0.05)and SH(OR:1.403,P<0.05)were still prognostic factors for patients with acute myocardial infarction(after adjusting for confounding factors).3.The area under ROC curve of three blood glucose indexes in diabetic group was compared,SH-AUC value was 0.751(95%CI 0.661-0.841,P<0.001),SHR-AUC value was 0.704(95%CI 0.611-0.789,P<0.001).The value of HbAlc-AUC was 0.657(95%CI 0.562-0.751,P=0.002).Medcalc software was used to compare the ROC curves of SHR and SH for 6-month MACE events,and there was no significant difference in the prediction of 6-month MACE between the two(P=0.984).4.The area under ROC curve of SH and SHR in non-diabetic group was compared,and the results showed that SH-Auc value was 0.751(95%CI 0.661-0.841,P<0.001)and SHr-AUc value was 0.704(95%CI 0.611-0.789,P<0.001).When Medcalc software was used to compare the ROC curves of 6-month MACE events between SHR and SH,there was no significant difference in the prediction of 6-month MACE(P=0.749).Conclusions High SH and SHR are risk factors for poor prognosis in AMI patients regardless of whether they are complicated with diabetes,while HbAlc is mainly a risk factor for poor prognosis in AMI patients complicated with diabetes.The predictive value of SHR is not better than that of admitted blood glucose,which is more intuitive and easy to obtain than SHR,so it is more recommended to use admitted blood glucose to evaluate the prognosis of AMI patients.It may be of guiding significance to use admission blood glucose for early identification of patients at high risk of AMI. |
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