Glycemic State as a Predictor of Adverse Cardiac Events in ST-Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention versus Thrombolytic Therapy Among Non-Diabetic Patients

Background: In diabetic patients with acute coronary syndromes, hyperglycemia is a known predictor of poor outcomes, emerging evidence suggests that glycemic state metrics including glycated hemoglobin (HbA1c), and fasting blood glucose levels may also be useful in predicting outcomes for patients withST-elevation myocardial infarction (STEMI) who are not diabetic. Admission random blood glucose is an indicator of acute hyperglycemia in this context. It has been linked to a higher risk of serious cardiac events and is frequently a sign of a stress reaction. It's still unknown how useful these markers are for predicting outcomes in patients with STEMI who are not diabetic.
Objective: This study aimed to determine whether glycemic status measures may predict unfavorable cardiac outcomes in individuals who did not have diabetes but were presenting with STEMI to provide insights into risk stratification and management strategies for these patients.
Method: 144 patients with a diagnosis of STEMI who had not previously been diagnosed with diabetes participated in this prospective cohort study. All patients underwent full history taking, general & local cardiac examinations, ECG, plain chest X-ray & full laboratory investigations including HbA1c, FBS & RBS during the preliminary diagnostic procedure. Each patient had a two-dimensional transthoracic echocardiogram within 72 hours of symptom onset, during the index hospitalization. Cardiac catheterization and coronary angiography were performed 90-120 min from presentation in primary percutaneous coronary intervention (PPCI) group & within 24 hours in patients who received thrombolytic therapy (pharmaco-invasive strategy).
Results: This study showed statistically significant higher mean value in adverse cardiac events group at admission RBS, FBS and HbA1c (%) (153.50 ± 26.19, 113.50 ± 17.30 and 6.04 ± 0.43 respectively) compared to no adverse cardiac events at admission RBS, FBS and HbA1c (%) (113.63±17.23, 100.14±11.28 and 5.04±0.48 respectively), [p-value (p < 0.05)]. The HbA1c and admission RBS have a significant prognostic value of adverse cardiac events [OR (C.I.95%), p-value] [11.228 (1.785-70.633) P=0.010 and 1.052 (1.006-1.101) P=0.027 respectively].
Conclusion: That glycemic state specifically HbA1c and admission random blood sugar (RBS) are reliable indicators of unfavorable cardiac outcomes in people without diabetes who had ST-elevation myocardial infarction (STEMI).