MỐI LIÊN QUAN GIỮA TĂNG KHOẢNG TRỐNG ĐƯỜNG HUYẾT VÀ KẾT CỤC NỘI VIỆN Ở NGƯỜI BỆNH NHỒI MÁU CƠ TIM CẤP CÓ ĐÁI THÁO ĐƯỜNG

Abstract

Background: The association between acute hyperglycemia and adverse outcomes in diabetic mellitus (DM) patients with acute myocardial infarction (AMI) is still a subject of debate. A glycemic gap is introduced as a new parameter to evaluate the association between acute hyperglycemia and inhospital adverse outcomes in DM patients presenting with AMI.  Objective: To study the relationship between glycemic gap and the occurence of inhospital clinical adverse events in DM patients with AMI. Methods: A prospective observational study was conducted on 100 diabetic patients with AMI admitted to the Interventional cardiology Department of Cho Ray hospital from March to September 2022. Admission blood glucose and HbA1c were measured and glycemic gap was calculated using the equation: glycemic gap = admission serum glucose level – (28,7 x HbA1c - 46,7) (mg/dL). The correlation and association between glycemic gap and clinical adverse events were evaluated using Pearson correlation and multivariate regression analysis. Results: We collected 100 AMI patients with DM (male:female ratio of 0.85:1) at average age of mean ± standard deviation (SD) = 65.6 ± 11.2. The median value of glycemic gap was 52.2 mg/dL (interquartile range: 39.0 - 94.4 mg/dL). There was a statistically significant strong correlation (r=0.634, p<0.001) and prognostic association between the glycemic gap and major adverse cardiac events (MACEs) that may occur to the AMI patients with DM during hospitalization. In the analysis of the ROC curve for glycemic gap value to predict MACEs, the optimal cutoff value of the glycemic gap was 56.9 mg/dL, with maximum AUROC of 0.917 (95% Cl = 0.865-0.969), (sensitivity 91.7%, specificity 79.7%). Conclusion: Elevated glycemic gaps were associated with an increased risk of major adverse cardiac events. Glycemic gap could be considered as an additional parameter to evaluate the impact of stress-induced hyperglycemia on inhospital clinical outcomes in diabetic patients with AMI.