Stress hyperglycemia and poor outcomes in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis
BackgroundHyperglycemia, characterized by elevated blood glucose levels, is frequently observed in patients with acute coronary syndrome, including ST-elevation myocardial infarction (STEMI). There are conflicting sources regarding the relationship between hyperglycemia and outcomes in STEMI patient...
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| Format: | Article |
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Frontiers Media S.A.
2024-03-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1303685/full |
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| author | Abdul Hakim Alkatiri Abdul Hakim Alkatiri Nurul Qalby Nurul Qalby Idar Mappangara Idar Mappangara Ahmad Taufik F. Zainal Maarten J. Cramer Pieter A. Doevendans Pieter A. Doevendans Andriany Qanitha Andriany Qanitha Andriany Qanitha |
| author_facet | Abdul Hakim Alkatiri Abdul Hakim Alkatiri Nurul Qalby Nurul Qalby Idar Mappangara Idar Mappangara Ahmad Taufik F. Zainal Maarten J. Cramer Pieter A. Doevendans Pieter A. Doevendans Andriany Qanitha Andriany Qanitha Andriany Qanitha |
| author_sort | Abdul Hakim Alkatiri |
| collection | DOAJ |
| description | BackgroundHyperglycemia, characterized by elevated blood glucose levels, is frequently observed in patients with acute coronary syndrome, including ST-elevation myocardial infarction (STEMI). There are conflicting sources regarding the relationship between hyperglycemia and outcomes in STEMI patients. We aimed to compile evidence to assess the association between hyperglycemia and adverse outcomes.MethodsWe conducted a comprehensive search for articles on PubMed and Embase using search strategies which yielded 4,061 articles. After full-text screening, 66 articles were included for systematic review, and 62 articles were further selected for meta-analysis.ResultsThe 66 included articles spanned the years 2005–2023. Of these, 45 articles reported admission blood glucose, 13 articles used HbA1c, and 7 articles studied fasting blood glucose. Most studies defined STEMI with primary PCI as their inclusion criteria. Mortality was the most often outcome reported related to hyperglycemia. Overall, 55 (83.3%) studies were at low risk of bias. Both admission and fasting blood glucose were significantly related to short- and long-term mortality after STEMI, with a pooled risk ratio (RR) of 3.02 (95%CI: 2.65–3.45) and 4.47 (95% CI: 2.54–7.87), respectively. HbA1c showed substantial association with long-term mortality (HR 1.69, 95% CI: 1.31–2.18)) with a pooled RR of 1.58 (95% CI 1.26–1.97). In subsequent analyses, admission hyperglycemia was associated with an increased risk of reinfarction (pooled RR 1.69, 95% CI 1.31–2.17), heart failure (pooled RR 1.56, 95% CI: 1.37–1.77), cardiogenic shock (pooled RR 3.68, 95% CI 2.65–5.11), repeat PCI or stent thrombosis (pooled RR 1.99, 95% CI 1.21–3.28), and composite major adverse cardiac and cerebrovascular events (MACCE) (pooled RR 1.99, 95% CI: 1.54–2.58).ConclusionsOur study demonstrated that hyperglycemia has a strong association with poor outcomes after STEMI. Admission and fasting blood glucose are predictors for short-term outcomes, while HbA1c is more appropriate for predicting longer-term outcomes in STEMI patients.Systematic Review RegistrationPROSPERO 2021 (CRD42021292985). |
| first_indexed | 2024-04-25T01:00:06Z |
| format | Article |
| id | doaj.art-0666a7ba796d4166aa256c58b54958da |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-25T01:00:06Z |
| publishDate | 2024-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-0666a7ba796d4166aa256c58b54958da2024-03-11T05:03:51ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2024-03-011110.3389/fcvm.2024.13036851303685Stress hyperglycemia and poor outcomes in patients with ST-elevation myocardial infarction: a systematic review and meta-analysisAbdul Hakim Alkatiri0Abdul Hakim Alkatiri1Nurul Qalby2Nurul Qalby3Idar Mappangara4Idar Mappangara5Ahmad Taufik F. Zainal6Maarten J. Cramer7Pieter A. Doevendans8Pieter A. Doevendans9Andriany Qanitha10Andriany Qanitha11Andriany Qanitha12Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, IndonesiaMakassar Cardiac Center, Dr. Wahidin Sudirohusodo General Teaching Hospital, Makassar, IndonesiaDepartment of Public Health and Community Medicine, Faculty of Medicine, Hasanuddin University, Makassar, IndonesiaHeart and Lung Division, Department of Cardiology, University Medical Center Utrecht, Utrecht, NetherlandsDepartment of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, IndonesiaMakassar Cardiac Center, Dr. Wahidin Sudirohusodo General Teaching Hospital, Makassar, IndonesiaFaculty of Medicine, Hasanuddin University, Makassar, IndonesiaHeart and Lung Division, Department of Cardiology, University Medical Center Utrecht, Utrecht, NetherlandsHeart and Lung Division, Department of Cardiology, University Medical Center Utrecht, Utrecht, NetherlandsNetherlands Heart Institute, Utrecht, NetherlandsDepartment of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, IndonesiaDepartment of Physiology, Faculty of Medicine, Hasanuddin University, Makassar, IndonesiaDoctoral Study Program, Faculty of Medicine, Hasanuddin University, Makassar, IndonesiaBackgroundHyperglycemia, characterized by elevated blood glucose levels, is frequently observed in patients with acute coronary syndrome, including ST-elevation myocardial infarction (STEMI). There are conflicting sources regarding the relationship between hyperglycemia and outcomes in STEMI patients. We aimed to compile evidence to assess the association between hyperglycemia and adverse outcomes.MethodsWe conducted a comprehensive search for articles on PubMed and Embase using search strategies which yielded 4,061 articles. After full-text screening, 66 articles were included for systematic review, and 62 articles were further selected for meta-analysis.ResultsThe 66 included articles spanned the years 2005–2023. Of these, 45 articles reported admission blood glucose, 13 articles used HbA1c, and 7 articles studied fasting blood glucose. Most studies defined STEMI with primary PCI as their inclusion criteria. Mortality was the most often outcome reported related to hyperglycemia. Overall, 55 (83.3%) studies were at low risk of bias. Both admission and fasting blood glucose were significantly related to short- and long-term mortality after STEMI, with a pooled risk ratio (RR) of 3.02 (95%CI: 2.65–3.45) and 4.47 (95% CI: 2.54–7.87), respectively. HbA1c showed substantial association with long-term mortality (HR 1.69, 95% CI: 1.31–2.18)) with a pooled RR of 1.58 (95% CI 1.26–1.97). In subsequent analyses, admission hyperglycemia was associated with an increased risk of reinfarction (pooled RR 1.69, 95% CI 1.31–2.17), heart failure (pooled RR 1.56, 95% CI: 1.37–1.77), cardiogenic shock (pooled RR 3.68, 95% CI 2.65–5.11), repeat PCI or stent thrombosis (pooled RR 1.99, 95% CI 1.21–3.28), and composite major adverse cardiac and cerebrovascular events (MACCE) (pooled RR 1.99, 95% CI: 1.54–2.58).ConclusionsOur study demonstrated that hyperglycemia has a strong association with poor outcomes after STEMI. Admission and fasting blood glucose are predictors for short-term outcomes, while HbA1c is more appropriate for predicting longer-term outcomes in STEMI patients.Systematic Review RegistrationPROSPERO 2021 (CRD42021292985).https://www.frontiersin.org/articles/10.3389/fcvm.2024.1303685/fulladverse outcomeshyperglycemiaMACCEmortalitySTEMIrevascularization |
| spellingShingle | Abdul Hakim Alkatiri Abdul Hakim Alkatiri Nurul Qalby Nurul Qalby Idar Mappangara Idar Mappangara Ahmad Taufik F. Zainal Maarten J. Cramer Pieter A. Doevendans Pieter A. Doevendans Andriany Qanitha Andriany Qanitha Andriany Qanitha Stress hyperglycemia and poor outcomes in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis Frontiers in Cardiovascular Medicine adverse outcomes hyperglycemia MACCE mortality STEMI revascularization |
| title | Stress hyperglycemia and poor outcomes in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis |
| title_full | Stress hyperglycemia and poor outcomes in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis |
| title_fullStr | Stress hyperglycemia and poor outcomes in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis |
| title_full_unstemmed | Stress hyperglycemia and poor outcomes in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis |
| title_short | Stress hyperglycemia and poor outcomes in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis |
| title_sort | stress hyperglycemia and poor outcomes in patients with st elevation myocardial infarction a systematic review and meta analysis |
| topic | adverse outcomes hyperglycemia MACCE mortality STEMI revascularization |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1303685/full |
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