Hyperglycemia and leukocytosis as predictive factors of in-hospital complications in patients with Acute myocardial infarction
Keywords:
myocardial infarction, hyperglycemia, leukocytosis, in-hospital complications.Abstract
Introduction: Despite the use of novel techniques for reperfusion of the vessel in acute myocardial infarction, complications and mortality in these patients are high. Hyperglycemia and leukocytosis have been described as risk factors and worse prognosis.
Objective: To evaluate the predictive capacity of hyperglycemia and leukocytosis for in-hospital complications of myocardial infarction with ST-segment elevation patients.
Material and Methods: Prospective cohort study conducted from 2013 to 2020 that included 507 consecutive patients admitted to the Intensive Coronary Care Unit of the "Dr. Carlos J. Finlay" Central Military Hospital and the "Enrique Cabrera” General Teaching Hospital with the diagnosis of acute myocardial infarction with ST- segment elevation. The patients were divided into groups according to the occurrence of in-hospital complications.
Results: The values of glycemia and leukocyteswere significantly different among the groups of patients (p = 0.002 and p = 0.005; respectively). The discriminative capability of both tests was classified as bad. The univariate analysis of logistic regression revealed that glycemia and leukocytes were risk factors for the appearance of complications, but only the leukocyte test was considered as an independent predictor of the final event of the study. When the values of the leukocyte test were associated with the multivariate model, its predictive capacity increased (area under curve: 0.735; p < 0.001).
Conclusions: Leukocytosis is an independent predictor of in-hospital complications of acute myocardial infarction with ST-segment elevation.Downloads
References
1. Mozaffarian D, Benjamin EJ, Go AS. Heart disease and stroke statistics−2016 update: a report from the American Heart Association. Circulation [Internet]. 2016;133(4):e38-360. Disponible en: https://doi.org/10.1161/CIR.0000000000000350
2. Ministerio de Salud Pública Cuba. Anuario Estadístico de Salud 2020 [Internet]. La Habana: MINSAP; 2021 [Citado 20/08/2021]. Disponible en: http://bvscuba.sld.cu/anuario-estadisticode-cuba//2020
3. Montecucco F, Carbone F, Schindler TH. Pathophysiology of ST-segment elevation myocardial infarction: novel mechanisms and treatments. Eur Heart J [Internet]. 2016;37(16):1268-83. Disponible en: https://doi.org/10.1093/eurheart/ehv592
4. Frangogiannis NG. Inflammation in cardiac injury, repair and regeneration. Curr Opinion in Cardiol [Internet]. 2015 [Citado 15/04/2021];30(3):240-5. Disponible en: https://pubmed.ncbi.nlm.nih.gov/25807226/
5. De Berge M, Yeap XY, Dehn S. MerTK cleavage on resident cardiac macrophages compromises repair after myocardial ischemia reperfusion injury. Circulation Research [Internet]. 2017;121(8):930-40. Disponible en: https://doi.org/10.1161/CIRCRESAHA.117.311327
6. Bajpai G, Bredemeyer A, Li W, Zaitsev K, Koening AL, Lokshina I, et al. Tissue resident CCR2− and CCR2+ cardiac macrophages differentially orchestrate monocyte recruitment and fate specification following myocardial injury. Circulation Research [Internet]. 2019;124(2):263-78. Disponible en: https://doi.org/10.1161/CIRCRESAHA.118.314028
7. Ruparelia N, Chai JT, Fisher EA, Choudhury RP. Inflammatory processes in cardiovascular disease: a route to targeted therapies. Nat Rev Cardiol [Internet]. 2017;14:133-44. Disponible en: https://doi.org/10.1038/nrcardio.2016.185
8. Duncan SE, Gao S, Sarhene M, Coffie JW, Linhua D, Bao X, et al. Macrophage Activities in Myocardial Infarction and Heart Failure. Cardiology Research and Practice [Internet]. 2020;2020:[Aprox. 16 p.] Disponible en: https://doi.org/10.1155/2020/4375127.
9. Mi Sh, Su G, Yang H, Zhou Y, Tian L, Zhang T, et al. Comparison of in-hospital glycemic variability and admission blood glucose in predicting short-term outcomes in non-diabetes patients with ST elevation myocardial infarction underwent percutaneous coronary intervention. Diabetol Metab Syndr [Internet]. 2017;9:[Aprox. 8 p.]. Disponible en: https://doi.org/10.1186/s13098-017-0217-1
10. Pesaro AEP, Nicolau JC, Serrano CV, Truffa R, Gaz MVB, Karbstein R, et al. Influencia de Leucocitos y Glucemia en el Pronóstico de Pacientes con Infarto Agudo de Miocardio. Arq Bras Cardiol [Internet]. 2009 [Citado 09/07/2021];92(2):84-9. Disponible en: https://www.scielo.br/j/abc/a/QHcPzmWnNb5vqTLHvY5TzpQ/abstract/?lang=es
11. ChacónDíaz M, Vega A, Araoz O, Ríos P, Baltodano R, Villanueva F, et al. Características epidemiológicas del infarto de miocardio con elevación del segmento ST en Perú: resultados del P Eruvian Registry of ST-segment Elevation Myocardial Infarction (PERSTEMI). Arch Cardiol Mex [Internet]. 2018 [Citado 23/08/2021];88(5):403-12. Disponible en: http://www.scielo.org.mx/pdf/acm/v88n5/1665-1731-acm-88-05-403.pdf
12. García Aurelio MJ, Cohen Arazi H, Higa C, Gómez HR, Mauro V, Fernández H, et al. Infarto agudo de miocardio con supradesnivel persistente del segmento ST. Registro multicéntrico SCAR (Síndromes Coronarios Agudos en Argentina) de la Sociedad Argentina de Cardiología. Rev Argent Cardiol [Internet]. 2014 [Citado 14/07/2021];82:275-84. Disponible:http://www.old2.sac.org.ar/wp-content/uploads/2014/08/v82n4a04-es.pdf
13. Gagliardi JA, Charask A, Perna E, D´Imperio H, Bono H, Castillo Y, et al. Encuesta nacional de infarto agudo de miocardio con elevación del ST en la República Argentina (ARGEN-IAM-ST). Rev Argent Cardiol [Internet]. 2016 [Citado 12/07/2021];84:548-57. Disponible en: http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1850-37482016000600006
14. Lee KH, Jeong MH, Ahn Y, Cho MC, Kim CJ, Kim YJ. New Horizons of Acute Myocardial Infarction: From the Korea Acute Myocardial Infarction Registry (KAMIR). J Korean Med Sci [Internet]. 2013;28:173-80. Disponible en: http://dx.doi.org/10.3346/jkms.2013.28.2.173
15. Hoedemaker NPG, ten Haaf ME, Maas JC, Damman P, Appelman Y, Tijssen JGP, et al. Practice of ST-segment elevation myocardial infarction care in the Netherlands during four snapshot weeks with the National Cardiovascular Database Registry for Acute Coronary Syndrome. Neth Heart J [Internet]. 2017;25:264-70. Disponible en: http://doi.org/10.1007/s12471-017-0947-6
16. Melo de Barros PGS, Berwanger O, Silva ES, Sobral ACS, Assad MC, Beraldo PA, et al. Avaliação do Seguimento de um Ano dos Pacientes Incluídos no Registro Brasileiro de Síndromes Coronárias Agudas (ACCEPT). Arq Bras Cardiol [Internet]. 2020;114(6):995-1003. Disponible en: https://doi.org/10.36660/abc.20190879
17. García García C, Oliveras T, Serra J, Vila J, Rueda F, Cediel G, et al. Trends in Short- and Long-Term ST-Segment–Elevation Myocardial Infarction Prognosis Over 3 Decades: A Mediterranean Population-Based ST-Segment–Elevation Myocardial Infarction Registry. J Am Heart Assoc [Internet]. 2020;9:e017159. Disponible en: http://doi.org/10.1161/JAHA.120.017159
18. Alhabib KF, Kinsara AJ, Alghamdi S, Al Murayeh M, Hussein GA, Al Saif S, et al. The first survey of the Saudi Acute Myocardial Infarction Registry Program: Main results and long-term outcomes (STARS-1 Program). PLoS ONE [Internet]. 2019;14(5):e0216551. Disponible en: https://doi.org/10.1371/journal.pone.0216551
19. Santos MM, Rodríguez MR, Prohias JM, Mata LAC, Martínez GG, Sellen ES, et al. Registro Cubano de Infarto de Miocardio Agudo (RECUIMA), los primeros 1000 casos. Rev Cub Cardiol Cir Cardiovasc [Internet]. 2019 [Citado 21/08/2021];25(3 Suppl 1):419-35. Disponible en: http://www.revcardiologia.sld.cu/index.php/revcardiologia/article/view/895
20. Chen C, Cong BL, Wang M, Abdullah M, Long XW, Hua YZ, et al. Neutrophil to lymphocyte ratio as a predictor of myocardial damage and cardiac dysfunction in acute coronary syndrome patients. IntegrMed Res [Internet]. 2018:7(2):192-9. Disponible en: https://doi.org/10.1016/j.imr.2018.02.006
21. Hong D, Hong KC, Bin YS, Myung JL, Kyu TP, Hoon JY, et al. Prognostic implications of post-percutaneous coronary intervention neutrophil-to-lymphocyte ratio on infarct size and clinical outcomes in patients with acute myocardial infarction. Scien Rep [Internet]. 2019;9(1):9646 [Aprox. 9 p.]. Disponible en: https://doi.org/10.1038/s41598-019-46117-8
22. Akhtar N, Adil MM, Ahmed W, Habib-ur-Rehman, Shahs MA. The role of leukocyte counts in patients with unstable angina pectoris or myocardial infarction: prognostic significance and correlation with plasma brain natriuretic peptide (BNP) levels. J Pak Med Assoc [Internet]. 2011 Jan [Citado 14/05/2021];61(1):51-4. Disponible en:https://pubmed.ncbi.nlm.nih.gov/22368903/
23. Gomez Arbelaez D, Sánchez Vallejo G, Perez M, Garcia RG, Freddy JA, Peñaherrera E, et al. Hiperglucemia se asocia a mayor número de desenlaces adversos en individuos latinoamericanos con infarto agudo de miocardio. Clin Investig Arterioscl [Internet]. 2016;28(1):9-18. Disponible en: http://dx.doi.org/10.1016/j.arteri.2015.09.003
24. Issa M, Alqahtani F, Berzingi C, AlHajji M, Busu T, Alkhouli M. Impact of acute diabetes decompensation on outcomes of diabetic patients admitted with ST-elevation myocardial infarction. Diabetol Metab Syndr [Internet]. 2018 [Citado 17/06/2021];10:[Aprox. 8p.]. Disponible en: https://doi.org/10.1186/s13098-018-0357-y
25. Kalińczuk Ł, Zieliński K, Pręgowski J, Przyłuski J, Karcz M, Bekta P, et al. Higher admission glycaemia independently of diagnosed or unrecognized diabetes mellitus is a risk factor for failed myocardial tissue reperfusion and higher mortality after primary angioplasty. Kardiologia Polska [Internet]. 2018 [Citado21/07/2021];76(3):594-601. Disponible en: www.kardiologiapolska.pl
26. Karetnikova V, Gruzdeva O, Uchasova E, Osokina A, Barbarash O. Glucose levels as a prognostic marker in patients with ST-segment elevation myocardial infarction: a case–control study. BMC Endocrine Disorders [Internet]. 2016 [Citado 21/07/2021];16(1):31. Disponible en: https://doi.org/10.1186/s12902-016-0108-8
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