EFFECTS OF STRESS HYPERGLYCEMIA ACCORDING TO DIABETICSTATUS IN PATIENTS WITH ST-ELEVATION MYOCARDIALINFARCTION AND ITS RELATIONSHIP WITH CARDIAC CELL INJURYAND MITOCHONDRIAL DAMAGE: A TRANSLATIONAL APPROACH
Tesi di Dottorato
Data di Pubblicazione:
2023
Citazione:
EFFECTS OF STRESS HYPERGLYCEMIA ACCORDING TO DIABETICSTATUS IN PATIENTS WITH ST-ELEVATION MYOCARDIALINFARCTION AND ITS RELATIONSHIP WITH CARDIAC CELL INJURYAND MITOCHONDRIAL DAMAGE: A TRANSLATIONAL APPROACH / N. Cosentino ; tutor: G. Marenzi, P. Agostoni ; coordinator: C. Sforza. Dipartimento di Scienze Cliniche e di Comunità, 2023 Jan 23. 35. ciclo, Anno Accademico 2022.
Abstract:
Background: Acute hyperglycemia (AH) is common in ST-elevation myocardial
infarction (STEMI) and predicts outcomes. AH is a more powerful prognostic
predictor in patients without diabetes mellitus (DM) than with DM, emphasizing the
role of an acute glucose rise compared to chronic elevations. Moreover, AH may
exacerbate, thorough mitochondrial dysfunction, infarct size (IS). We investigated
the association between AH and chronic glycemia, considered separately or in
combination, with mitochondrial injury and myocardial IS in STEMI patients with or
without DM.
Methods: We measured admission serum glucose (AH), cytochrome c and
mitochondrial DNA levels (mitochondrial biomarkers), and estimated chronic
glucose in all patients. We calculated the acute on chronic (A/C) glycemic ratio. The
primary endpoint was IS at cardiac magnetic resonance. The composite of in hospital mortality, acute-pulmonary-edema, and shock was the secondary endpoint.
Results: 100 STEMI patients with DM and 100 without were included. IS was 25gr
and 19gr and the secondary endpoint occurred in 21% and 8% of patients with and
without DM, respectively (p=0.02 and p=0.01, respectively). The A/C ratio only
significantly correlated with cytochrome c and mitochondrial DNA levels in DM
patients. However, at reclassification analyses, A/C glycemic ratio showed the best
prognostic power in predicting the primary and secondary endpoints as compared
to AH in DM (net-reclassification-index 28% and 31%, respectively) but not in non DM patients (net-reclassification-index 1% and 2%, respectively). In DM patients,
A/C glycemic ratio, but not AH, significantly predicted 1-year mortality, after
adjustment for major confounders.
4
Conclusions: In STEMI patients with DM, A/C glycemic ratio seems to be a better
predictor of IS and in-hospital and 1-year outcome than AH. This study highlights
the prognostic role of A/C ratio, its impact on mitochondrial impairment and
outcomes, and may pave the way to interventional trials targeting AH according to
A/C ratio in DM patients with STEMI.
Tipologia IRIS:
Tesi di dottorato
Keywords:
ST-elevation myocardial infarction; diabetes mellitus; acute hyperglycemia; chronic glycemia; acute/chronic glycemic ratio; mitochondrial injury; outcomes.
Elenco autori:
N. Cosentino
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