China: In patients with acute STEMI, the glycemic gap may predict all-cause mortality and MACE within 30 days, a recent journal Atherosclerosis has found. GAPmean is the difference between mean blood sugar within 24 hours after admission and A1c-derived average glucose (ADAG).
Stress-induced hyperglycemia (SIH) is a common occurrence in critical illness. The glycemic gap (GAP) has recently been considered a superior indicator of SIH. However, there is limited data on the association between GAP and prognosis in ST-segment elevation myocardial infarction (STEMI). Shuang Wu, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China, and colleagues, therefore, aimed to estimate the predictive value of GAPmean in patients with acute STEMI.

The final analysis included a total of 4952 patients with acute STEMI. They were categorized into four groups according to GAPmean quartiles and diabetes mellitus (DM). The primary outcomes were major adverse cardiovascular events (MACEs) and all-cause mortality. The researchers also performed Cox proportional hazards regression analysis and net reclassification improvement (NRI) analysis.
The study led to the following findings:
At 30 days of follow-up, 6.5% deaths and 11.5% MACEs.
The risk of all-cause mortality (4.0%, 5.6%, 6.5%, and 10.1%) and MACEs (7.3%, 9.6%, 11.4%, and 17.7%) increased remarkably with the elevation of GAPmean.
Receiver operating characteristic curve analysis showed that GAPmean was better than admission blood sugar and GAPadm (defined as the difference between ABG and ADAG) for detecting adverse outcomes.
Multivariate Cox regression analysis demonstrated that increased GAPmean was independently associated with MACEs and all-cause death.
The hazards ratios for all-cause death in the second, third, and fourth quartiles with the first quartile as the reference were respectively 1.49, 1.58, and 2.11, and the HRs for MACEs were 1.40, 1.60, and 2.17, respectively, which were independent diabetes status.
Continuous NRI analysis showed that GAPmean significantly improved risk stratification for all-cause mortality and MACEs by 21.6% and 19.8%, respectively.
"The glycemic gap between mean blood glucose level (MGL) within 24 hours after admission and A1c-derived average glucose (ADAG) was linked with 30-day all-cause mortality and MACEs in acute STEMI patients, which was affected by DM status," researchers wrote in their study. "Further, the glycemic gap provided incremental accuracy in STEMI's risk stratification."
To conclude, GAPmean is superior to admission blood sugar and GAPadm for predicting all-cause mortality and MACEs.
Reference:
The "Impact of glycemic gap on 30-day adverse outcomes in patients with acute ST-segment elevation myocardial infarction," was published in Atherosclerosis.
DOI: https://doi.org/10.1016/j.atherosclerosis.2022.10.003