Association between Admission Hyperglycemia and Culprit Lesion Characteristics in Nondiabetic Patients with Acute Myocardial Infarction: An Intravascular Optical Coherence Tomography Study
Jinying Zhou, Zhaoxue Sheng, Chen Liu, Peng Zhou, Jiannan Li, Runzhen Chen, Li Song, Hanjun Zhao, Hongbing Yan
Abstract
Background . Hyperglycemia is frequently observed in acute myocardial infarction (AMI). Diabetes mellitus (DM) patients and non-DM patients have different culprit lesion phenotypes and few data are available on non-DM patients with admission hyperglycemia. Therefore, we aimed to investigate the association between admission hyperglycemia and culprit lesion characteristics using optical coherence tomography (OCT) in AMI patients. Methods and Results . We consecutively enrolled 434 patients with AMI, and 277 patients were included in analysis: 65.7% (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mi>n</mml:mi><mml:mo>=</mml:mo><mml:mn>182</mml:mn></mml:math>) non-DM patients and 34.3% (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mi>n</mml:mi><mml:mo>=</mml:mo><mml:mn>95</mml:mn></mml:math>) DM patients. We measured acute blood glucose (ABG) and hemoglobin A 1c to calculate the acute-to-chronic glycemic ratio (A/C). Then, we grouped non-DM patients into tertiles of A/C. OCT-based culprit lesion characteristics were compared across A/C tertiles in non-DM patients and between DM and non-DM patients. Non-DM patients had fewer lipid-rich plaques (52.7% versus 68.4%, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.012</mml:mn></mml:math>) and thin-cap fibroatheroma (TCFA) (19.8% versus 34.7%, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.006</mml:mn></mml:math>) than DM patients but similar prevalence of plaque rupture (47.3% versus 56.8%, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.130</mml:mn></mml:math>). Non-DM patients with the highest A/C tertile had the highest prevalence of plaque rupture (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M6"><mml:msub><mml:mrow><mml:mi>p</mml:mi></mml:mrow><mml:mrow><mml:mtext>for</mml:mtext><mml:mtext> </mml:mtext><mml:mtext>trend</mml:mtext></mml:mrow></mml:msub><mml:mo>=</mml:mo><mml:mn>0.002</mml:mn></mml:math>), lipid-rich plaque (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M7"><mml:msub><mml:mrow><mml:mi>p</mml:mi></mml:mrow><mml:mrow><mml:mtext>for</mml:mtext><mml:mtext> </mml:mtext><mml:mtext>trend</mml:mtext></mml:mrow></mml:msub><mml:mo>=</mml:mo><mml:mn>0.001</mml:mn></mml:math>), and TCFA (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M8"><mml:msub><mml:mrow><mml:mi>p</mml:mi></mml:mrow><mml:mrow><mml:mtext>for</mml:mtext><mml:mtext> </mml:mtext><mml:mtext>trend</mml:mtext></mml:mrow></mml:msub><mml:mo>=</mml:mo><mml:mn>0.003</mml:mn></mml:math>). <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M9"><mml:mtext>A</mml:mtext><mml:mo>/</mml:mo><mml:mtext>C</mml:mtext><mml:mo>></mml:mo><mml:mn>1.22</mml:mn></mml:math> but not <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M10"><mml:mtext>ABG</mml:mtext><mml:mo>></mml:mo><mml:mn>140</mml:mn><mml:mtext> </mml:mtext><mml:mtext>mg</mml:mtext><mml:mo>/</mml:mo><mml:mtext>dl</mml:mtext></mml:math> predicted a high prevalence of plaque rupture, lipid-rich plaque, and TCFA in non-DM patients. Conclusions . In AMI patients without DM, admission hyperglycemia is associated with vulnerable culprit lesion characteristics, and A/C is a better predictor for vulnerable culprit plaque characteristics than ABG. These results call for a tailored evaluation and management of glucose metabolism in nondiabetic AMI patients. This trial is registered with NCT03593928 .