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Revista Colombiana de Cardiología
Print version ISSN 0120-5633
Abstract
IBRAHIM-FARAG, Shereen et al. The effect of elevated glycated hemoglobin on in-hospital and short-term outcome of patients with acute anterior myocardial infarction. Rev. Colomb. Cardiol. [online]. 2022, vol.29, n.2, pp.139-144. Epub May 19, 2022. ISSN 0120-5633. https://doi.org/10.24875/rccar.m22000134.
Introduction:
Hyperglycemia has a negative impact on morbidity and mortality among patients with acute myocardial infarction (AMI).
Objective:
The objective of the study was to evaluate the impact of chronic hyperglycemia on in-hospital and short-term outcome in patients with acute anterior MI treated with streptokinase as thrombolytic therapy.
Materials and methods:
A total of 100 patients with acute anterior myocardial infarction received streptokinase as thrombolytic therapy were enrolled. They were classified according to the admission glycated hemoglobin (HbA1c) level into two groups: Chronic hyperglycemic group (HbA1c ≥ 6.5%) (36 patients) and non-chronic hyperglycemic group (HbA1c <6.5%) (64 patients). Laboratory investigation, conventional echocardiography, and speckle tracking were performed.
Results:
Global longitudinal strain (GLS) was significantly lower in patients with chronic hyperglycemia group compared to non-chronic hyperglycemia group (−13.52 ± 4.83 vs. −15.27 ± 1.87%, p = 0.009). In-hospital outcome: Heart failure and reinfarction were significantly increased in patients with chronic hyperglycemia (45.5 vs. 16.7% and 18.2 vs. 3.3%, respectively, p < 0.05). Six months outcome: Heart failure, left ventricular (LV) remodeling, arrhythmias, and bleeding rates were significantly increased in patients with chronic hyperglycemia (41.9 vs. 12.1%, 51.6 vs. 13.8%, 6.5 vs. 1.7%, and 6.5 vs. 1.7%, respectively, p < 0.05). GLS cutoff value ≥ −13.5 has the best diagnostic accuracy in predicting LV remodeling (sensitivity: 100%, specificity: 93%, positive predictive value: 94%, negative predictive value: 100%, accuracy: 97%, and area under curve: 0.99).
Conclusion:
Chronic hyperglycemia had higher incidence of heart failure and LV remodeling following acute MI. GLS can be used as a predictor of LV remodeling.
Keywords : Glycated hemoglobin; Acute myocardial infarction; Left ventricular remodeling.