Leuko-glycemic index in patients with ST elevation myocardial infarction
Main Article Content
Keywords
Intrahospital Non-cardiovascular Complications, Prognosis, Cardiovascular Diseases, Myocardial Infarction, Diagnosis
Abstract
Background: The myocardial infarction-associated (MI) mortality is not only due cardiovascular complications, but intrahospital non-cardiovascular complications (IHnCVCs). The leuko-glycemic index (LGI) has been used as a prognostic marker for the development of cardiovascular complications in MI. We focused this study on identifying the cut-off point of LGI for the IHnCVCs development in patients with ST-segment elevation myocardial infarction (STEMI).
Material and methods: In this single-center and crosssectional design, we included patients with STEMI. The biochemical analysis included glucose and leucocytes; with them we calculated the LGI. Receiver operating characteristic curve, univariate and bivariate analysis, and multivariate analysis for IHnCVCs development were performed. A p < 0.05 was considered statistically significant.
Results: We included 1294 patients, 79.8% were men and 20.2% women. The main comorbidities were hypertension, diabetes mellitus and dyslipidemia. Six hundred forty-four (49.8%) patients presented IHNCVCs. The LGI > 1200 (AUC 0.817) predict the IHNCVCs development in STEMI patients. The variables that increased the IHNCVCs development were LGI > 1200, creatinine > 0.91 mg/dL, diabetes mellitus and age > 65 years. Hospital acquired pneumonia and cardiovascular complications increase the risk of death among STEMI patients.
Conclusion: A LGI > 1200 increased, just over nine times, the risk of IHnCVC development in STEMI patients.
References
Vázquez-Oliva G, Zamora A, Ramos R, Marti R, Subirana I, Grau M, et al. Acute Myocardial Infarction Population Incidence and Mortality Rates, and 28-day Case-fatality in Older Adults. The REGICOR Study. Rev Esp Cardiol (Engl Ed). 2018;71(9):718-725.
Nichols M, Townsend N, Luengo-Fernandez R . European Cardiovascular Disease Statistics 2012. European Heart Network, Brussels, European Society of Cardiology, Sophia Antipolis [cited 2017 Sep 18]. Available at: https://www. escardio.org/static_file/Escardio/Press-media/press-releases/2013/ EU-cardiovascular-disease-statistics-2012.pdf.
Writing Group Members, Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. 2016 26;133(4):e38-360.
GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018 10;392(10159):1736-1788.
Ioacara S, Sava E, Georgescu O, Sirbu A, Fica S. Recent diabetes-related mortality trends in Romania. Acta Diabetol. 2018;55(8):821-826.
Instituto nacional de estadística y geografía (INEGI). Inegi.org.mx. [Online]. Disponible en: https://www.inegi.org.mx/programas/mortalidad/ [Accessed 16 March 2021].
Flores-Salinas HE, Casillas-Muñoz F, Valle Y, Guzmán-Sánchez CM, Padilla-Gutiérrez JR. Good Practices in the Clinical Management of Patients with Acute Coronary Syndrome: Retrospective Analysis in a Third-Level Hospital in Mexico. Cardiol Res Pract. 2020;2020:9624283.
Martinez-Sanchez C, Borrayo G, Carrillo J, Juarez U, Quintanilla J, Jerjes-Sanchez C, et al. Clinical management and hospital outcomes of acute coronary syndrome patients in Mexico: The Third National Registry of Acute Coronary Syndromes (RENASICA III). Arch Cardiol Mex. 2016;86(3):221-32.
Ciambrone G, Higa CC, Gambarte J, Novo F, Nogues I, Borracci RA. Continuous Monitoring of Coronary Care Mortality Using the Global Registry for Acute Coronary Events (GRACE) Score. Crit Pathw Cardiol. 2020;19(3):126-130.
Zhu H, Xue H, Wang H, Chen Y, Zhou S, Tian F, Hu S, Wang J, Yang J, Zhang T. Risk stratification and prognostic value of GRACE and TIMI risk scores for female patients with non-ST segment elevation acute coronary syndrome. Minerva Cardioangiol. 2015;63(3):171-8.
Mello BH, Oliveira GB, Ramos RF, Lopes BB, Barros CB, Carvalho Ede O, Teixeira FB, Arruda GD, Revelo MS, Piegas LS. Validation of the Killip-Kimball classification and late mortality after acute myocardial infarction. Arq Bras Cardiol. 2014;103(2):107-17.
Khot UN, Jia G, Moliterno DJ, Lincoff AM, Khot MB, Harrington RA, et al. Prognostic importance of physical examination for heart failure in non-ST-elevation acute coronary syndromes: the enduring value of Killip classification. JAMA. 2003 Oct 22;290(16):2174-81.
Gutiérrez H, Vargas H, Rincón LE, Galván CG, Iñarra F. Complicaciones cardiovasculares en el infarto agudo de miocardio con elevación del segmento ST no reperfundido. Rev Sanid Milit Mex. 2017;71:349-65.
Quiroga W, Conci E, Zelaya F, Isa M, Pacheco G, Sala J, et al. Estratificación del riesgo en el infarto agudo de miocardio según el índice leucoglucémico. ¿El Killip-Kimball de laboratorio? Rev Fed Arg Cardiol, 2010 39, pp. 29-34
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018 7;39(2):119-177.
Pasupathy S, Air T, Dreyer RP, Tavella R, Beltrame JF. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation 2015;131(10):861–870.
OMS. Informe Mundial sobre el envejecimiento y la salud. WHO. https://www.who.int/ageing/publications/world-report-2015/es/
Martínez Saldaña A, Mendoza Rodríguez M, López González A. Índice leucoglucémico como predictor de complicaciones en el síndrome coronario agudo. Rev Asoc Mex Med Crit y Ter Int. 2018;32(1):27-33.
León AE, Pérez FG. Leucograma y glucemia en el pronóstico de pacientes con síndrome coronario agudo. Utilidad del índice leucoglucémico. Cor Salud. 2011;3(2):93-102.
Truffa A, Granger, C. White. Serious Infection Following Acute Myocardial Infarction: Incidence, Clinical Features, and Outcomes. JACC Cardiovasc Interv. 2012 5: 1-18
Mahmoud AN, Elgendy IY, Mojadidi MK, Wayangankar SA, Bavry AA, Anderson RD, et al. Prevalence, Causes, and Predictors of 30-Day Readmissions Following Hospitalization With Acute Myocardial Infarction Complicated By Cardiogenic Shock: Findings From the 2013-2014 National Readmissions Database. J Am Heart Assoc. 2018 23;7(6):e008235.
Cangemi R, Falcone M, Taliani G, Calvieri C, Tiseo G, Romiti GF, et al. Corticosteroid Use and Incident Myocardial Infarction in Adults Hospitalized for Community-acquired Pneumonia. Ann Am Thorac Soc. 2019;16(1):91-98.
Dombrowski NC, Karounos DG. Pathophysiology and management strategies for hyperglycemia for patients with acute illness during and following a hospital stay. Metabolism. 2013;62(3):326-336.
Martínez-Maicas H, Carbonell N, Palau P, Bodí V, Sanchis J. Prognostic implications of stress hyperglycemia in acute ST elevation myocardial infarction. Prospective observational study. Rev Esp Cardiol. 2011;64(3):201-207.
Pesaro A, Nicolau J, Serrano C, Truffa R, Gaz M, Karbstein R, et al. Influencia de leucocitos y glucemia en el pronóstico de pacientes con infarto agudo de miocardio. Arq Bras Cardiol.2009 92:84-89.
Article Sidebar
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors retain their copyright and grant the Revista Médica del IMSS the right of first publication. Articles are distributed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which allows sharing as long as the author and the original source are properly credited.