Discussion
diabetic status, STEMI, ischemia, hyperglycemia, diabetic, EJ, diabetic and non-diabetic, CIN, ACS, diabetes
ISCHEMIA, CARDIOGENIC SHOCK, CIN, HYPERGLYCEMIA, ACUTE CORONARY SYNDROME, ACUTE HYPERGLYCEMIA, STRESS HYPERGLYCEMIA, COMPLICATIONS, DIABETES
On admission, acute hyperglycemia is considered an independent prognosticator of both in-hospital and long-term outcomes, regardless of diabetic status in patients with acute coronary syndrome (ACS). Hence, in this study, we analyzed the incidence of acute hyperglycemia and its impact on subsequent adverse in-hospital outcomes, irrespective of diabetic status, in patients with STEMI undergoing primary PCI. Acute hyperglycemia was observed not only in diabetic but also in non-diabetic patients in a ratio of 25.0% and 65.4%, respectively. Acute hyperglycemia was found to be associated with an increased risk of mortality (5.7% vs. 2.5%; p < 0.001) in both people with diabetes (6.9% vs. 2.9%; p = 0.001) and non-diabetics (4.0% vs. 2.5%; p = 0.028) patients. Prolonged ischemia has been observed to be associated with acute hyperglycemia in both diabetic and non-diabetic patients.In concordance with our findings, Kim EJ et al. [In-hospital outcomes and complications such as mortality, cardiogenic shock, and CIN were found to be significantly higher among the stress hyperglycemia group. Qin Y et al. [As observed in our study, both acute and chronic hyperglycemia is associated with an increased risk of mortality, later higher than the former, after STEMI. However, a typical rise in admission plasma glucose level cannot differentiate between acute hyperglycemia and chronic hyperglycemia due to the major confounding effect of DM and the higher rate of undiagnosed DM, especially in our parts of the world [However, HbA1c is not a routine laboratory assessment for STEMI patients in most clinical setups, while random blood glucose and an easy-to-perform and routine laboratory assessment in the emergency room before primary PCI. Despite all its shortcomings, hyperglycemia is a marker for the inflammatory/stress state of the body in an acute situation; it has been found to be associated with prolonged ischemic time and increased risk of adverse clinical outcomes regardless of diabetic status. Even though it can not play a causative role by itself but it can be an attractive choice as a simple prognostic marker for early risk stratification of patients with STEMI.To our knowledge, this study is based on the largest cohort of STEMI patients from Pakistan, even though some limitations need to be acknowledged, including single-center experience, lack of short- or long-term follow-up, and lack of laboratory assessment of HbA1c for the confirmation of undiagnosed diabetes and differentiation of acute hyperglycemia and uncontrolled chronic hyperglycemia.