Affiliation:
1. Centro Cardiologico Monzino IRCCS, Milan, Italy
2. Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Italy
Abstract
Background
In acute myocardial infarction, acute hyperglycemia is a predictor of acute kidney injury (
AKI
), particularly in patients without diabetes mellitus. This emphasizes the importance of an acute glycemic rise rather than glycemia level at admission. We investigated whether, in diabetic patients with acute myocardial infarction, the combined evaluation of acute and chronic glycemic levels may have better prognostic value for AKI than admission glycemia.
Methods and Results
At admission, we prospectively measured glycemia and estimated average chronic glucose levels (mg/dL) using glycosylated hemoglobin (HbA
1c
), according to the following formula: 28.7×HbA
1c
(%)−46.7. We evaluated the association with
AKI
of the acute/chronic glycemic ratio and of the difference between acute and chronic glycemia (Δ
A−C
). We enrolled 474 diabetic patients with acute myocardial infarction. Of them, 77 (16%) experienced
AKI
. The incidence of
AKI
increased in parallel with the acute/chronic glycemic ratio (12%, 14%, 22%;
P
=0.02 for trend) and Δ
A−C
(13%, 13%, 23%;
P
=0.01) but not with admission glycemic tertiles (
P
=0.22). At receiver operating characteristic analysis, the acute/chronic glycemic ratio (area under the curve: 0.62 [95% confidence interval, 0.55–0.69];
P
=0.001) and Δ
A−C
(area under the curve: 0.62 [95% confidence interval, 0.54–0.69];
P
=0.002) accurately predicted
AKI
, without difference in the area under the curve between them (
P
=0.53). At reclassification analysis, the addition of the acute/chronic glycemic ratio and Δ
A−C
to acute glycemia allowed proper
AKI
risk prediction in 16% of patients.
Conclusions
In
diabetic
patients with acute myocardial infarction,
AKI
is better predicted by the combined evaluation of acute and chronic glycemic values than by assessment of admission glycemia alone.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
20 articles.
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