Prognostic Value of the Leuko-Glycemic Index in Acute Myocardial Infarction Patients with or without Diabetes

Figures & data

Figure 1 (A) The receiver operating characteristic (ROC) curve of leuko-glycemic index (LGI) to predict in-hospital mortality for AMI patients with diabetes. (B) The receiver operating characteristic (ROC) curve of leuko-glycemic index (LGI) to predict in-hospital mortality for AMI patients without diabetes.

Table 1 Baseline Characteristics

	Non-Diabetic Patients (n=930)	Diabetic Patients (n=326)	P value
Demographic
Age (years)	66(53, 77)	70(60, 78)	<0.001
Female (%)	22.8%	35.0%	<0.001
Medical history
Current smoking (%)	45.1%	33.1%	<0.001
Coronary heart disease (%)	10.0%	15.0%	0.014
Percutaneous coronary intervention (%)	2.7%	7.1%	<0.001
COPD (%)	4.1%	3.7%	0.748
Hypertension (%)	49.6%	69.9%	<0.001
Clinical characteristic
Clinical signs (%)
Chest pain	92.4%	89.6%	0.117
Dyspnea	5.3%	6.3%	0.506
Syncope	3.9%	4.4%	0.673
Nausea and vomiting	8.1%	10.0%	0.301
Profuse sweating	30.9%	26.0%	0.100
Systolic blood pressure (mmHg)	130(114, 147)	130(114, 150)	0.285
Diastolic blood pressure (mmHg)	78(70, 90)	76(66, 89)	0.023
Heart rate (beats per min)	78(67, 90)	80(68, 95)	0.013
Killip class (%)			0.087
I	63.5%	59.6%
II	21.3%	24.0%
III	4.2%	7.3%
IV	11.0%	9.1%
Killip class≥2	36.5%	40.4%	0.219
Laboratory values at hospital admission
BNP (ng/L)	292.80(84.40, 814.03)	338.38(106.65, 1184.83)	0.127
Serum creatinine (µmol/L)	80.30(67.70, 97.30)	84.10(69.30, 106.45)	0.020
Uric acid (µmol/L)	377.50(311.10, 457.00)	369.00(284.43, 450.00)	0.116
Triglyceride (mmol/L)	1.30(0.93, 1.93)	1.60(1.11, 2.38)	<0.001
Total cholesterol (mmol/L)	4.40(3.73, 5.15)	4.30(3.62, 5.15)	0.278
LDL-C (mmol/L)	2.74(2.18, 3.31)	2.55(2.07, 3.26)	0.061
HDL-C (mmol/L)	1.15(0.96, 1.39)	1.09(0.88, 1.28)	<0.001
Lp(a) (mg/L)	129.85(63.65, 312.53)	101.80(54.63, 260.75)	0.085
CRP (mg/L)	5.00(1.97, 18.48)	6.80(2.40, 24.12)	0.167
STEMI (%)	71.5%	63.8%	0.009
Coronary angiography (%)	78.9%	77.9%	0.702
Reperfusion therapy (%)	72.3%	75.2%	0.311
PCI (%)	71.7%	75.2%	0.232
Coronary artery
Multiple coronary arteries lesion (%)	63.8%	73.0%	0.007
Left main or anterior descending lesion (%)	56.4%	51.4%	0.181
Calcified lesions (%)	5.6%	8.6%	0.057
Medications at discharge
Antiplatelet agents (%)	99.0%	98.9%	0.932
Dual antiplatelet agents (%)	98.5%	97.9%	0.437
Statins (%)	96.0%	95.4%	0.650
ACEI/ARB (%)	54.7%	54.7%	0.996
Beta-blockers (%)	69.7%	71.9%	0.481

Abbreviations: COPD, chronic obstructive pulmonary disease; BNP, brain natriuretic polypeptide; LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol; Lp(a), lipoprotein a; CRP, C-reactive protein; STEMI, ST-segment elevation myocardial infarction; PCI, percutaneous coronary intervention; ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker.

Table 2 Baseline Characteristics of Patients with Different LGI Levels

	Non-diabetic Patients			Diabetic Patients
	Higher LGIGroup (n=311)	Lower LGIGroup (n=619)	P value	Higher LGI Group (n=57)	Lower LGI Group (n=269)	P value
Demographic
Age (years)	68(54, 77)	65(53, 76)	0.239	70(58, 79)	70(61, 78)	0.985
Female (%)	26.4%	21.0%	0.066	47.4%	32.3%	0.031
Medical history
Current smoking (%)	46.9%	44.1%	0.411	40.4%	31.6%	0.202
Coronary heart disease (%)	6.4%	11.8%	0.010	10.5%	16.0%	0.295
Percutaneous coronary intervention (%)	1.6%	3.2%	0.149	1.8%	8.2%	0.085
COPD (%)	3.9%	4.2%	0.804	3.5%	3.7%	0.939
Hypertension (%)	48.9%	49.9%	0.764	70.2%	69.9%	0.966
Clinical characteristic
Clinical signs (%)
Chest pain	91.6%	92.7%	0.555	86.0%	90.3%	0.327
Dyspnea	4.8%	5.3%	0.704	5.5%	6.4%	0.784
Syncope	3.2%	4.0%	0.507	5.5%	4.2%	0.671
Nausea and vomiting	11.6%	6.1%	0.005	12.7%	9.5%	0.464
Profuse sweating	36.0%	27.3%	0.009	27.3%	25.8%	0.816
Systolic blood pressure (mmHg)	123(108, 142)	130(116, 149)	<0.001	130(105, 155)	130(115, 170)	0.317
Diastolic blood pressure (mmHg)	76(66, 88)	80(70, 91)	0.001	77(64, 92)	76(67, 87)	0.847
Heart rate (beats per min)	80(68,96)	76(67,88)	0.001	89(61,99)	81(77,92)	0.218
Killip class (%)			<0.001			<0.001
I	52.9%	68.9%		40.0%	63.7%
II	21.2%	21.3%		21.8%	24.4%
III	4.2%	4.2%		10.9%	6.5%
IV	21.6%	5.7%		27.3%	5.3%
Killip class >2	47.1%	31.1%	<0.001	60.0%	36.3%	0.001
Laboratory values at hospital admission
BNP (ng/L)	334.10(109.30,985.30)	303.60(107.10,746.80)	0.699	302.74(163.65,441.05)	276.10(47.83,1301.23)	0.829
Serum creatinine (µmol/L)	82.40(67.20,103.75)	79.90(67.78,94.65)	0.068	94.25(75.50,121.25)	82.00(67.60,102.60)	0.017
Uric acid (µmol/L)	391.20(325.80, 468.28)	374.00(309.00, 450.08)	0.070	413.00(335.00, 511.00)	348.40(277.00, 441.30)	0.009
Triglyceride (mmol/L)	1.35(1.01,1.86)	1.27(0.89,1.83)	0.487	2.21(1.49,2.57)	1.78(1.20,2.46)	0.188
Total cholesterol (mmol/L)	4.53(4.03,5.46)	4.37(3.73,5.25)	0.012	4.73(4.66,5.11)	3.97(3.49,5.42)	0.038
LDL-C (mmol/L)	2.86(2.48,3.46)	2.73(2.18,3.24)	0.015	2.82(2.60,3.15)	2.46(2.02,3.56)	0.047
HDL-C (mmol/L)	1.17(0.95,1.40)	1.21(1.00,1.47)	0.311	1.10(1.00,1.24)	1.09(0.90,1.22)	0.210
Lp(a) (mg/L)	146.00(90.20,312.70)	121.10(59.00,293.60)	0.144	238.30(22.75,365.00)	90.75(36.23,233.23)	0.597
CRP (mg/L)	10.10(3.55,36.30)	5.00(2.30,14.40)	<0.001	7.00(3.90,32.65)	9.00(3.47,28.45)	0.913
STEMI (%)	82.0%	66.2%	<0.001	70.2%	62.5%	0.270
Coronary angiography (%)	81.4%	77.7%	0.199	77.2%	78.1%	0.885
Reperfusion therapy (%)	75.6%	70.6%	0.111	73.7%	75.5%	0.778
PCI (%)	75.6%	69.8%	0.065	73.7%	75.5%	0.778
Coronary artery
Multiple coronary arteries lesion (%)	63.3%	64.1%	0.828	80.5%	71.6%	0.238
Left main or anterior descending lesion (%)	56.6%	56.3%	0.944	37.5%	54.1%	0.054
Calcified lesions	11.1%	6.1%	0.024	12.3%	7.8%	0.273
Medications at discharge (%)
Antiplatelet agents	98.3%	99.3%	0.213	100.0%	98.7%	0.476
Dual antiplatelet agents	98.4%	98.5%	0.856	100.0%	97.4%	0.218
Statins	96.3%	95.9%	0.835	95.1%	95.5%	0.925
ACEI/ARB	53.3%	55.3%	0.613	55.6%	54.6%	0.913
Beta-blockers	70.7%	69.2%	0.671	75.0%	71.4%	0.636

Abbreviations: COPD, chronic obstructive pulmonary disease; BNP, brain natriuretic polypeptide; LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol; Lp(a), lipoprotein a; CRP, C-reactive protein; STEMI, ST-segment elevation myocardial infarction; PCI, percutaneous coronary intervention; ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker.

Table 3 Logistic Regression Analysis Results for in-Hospital Mortality

	Diabetic Patients	p-value for Trend (Adjusted)	Non-Diabetic Patients	p-value for Trend (Adjusted)
	Adjusted OR (95% CI)		Adjusted OR (95% CI)
Age	1.019(0.961, 1.081)	0.544	1.050(1.016, 1.086)	0.004
STEMI vs NSTEMI	6.785(1.001, 45.974)	0.050	1.799(0.650, 4.980)	0.258
Killip class≥2	1.848(0.377, 9.055)	0.449	4.199(1.500, 11.756)	0.006
Cardiogenic shock	13.827(2.302, 83.042)	0.004	4.520(1.928, 10.597)	0.001
CRP	0.993(0.976, 1.010)	0.429	1.004(0.995, 1.012)	0.381
LGI	1.000(1.000, 1.000)	0.807	1.001(1.000, 1.001)	0.001
PCI	0.259(0.051, 1.320)	0.104	0.401(0.177, 0.909)	0.029

Abbreviations: STEMI, ST-segment elevation myocardial infarction; NSTEMI, non-ST-elevation myocardial infarction; CRP, C-reactive protein; LGI, leuko-glycemic index; PCI, percutaneous coronary intervention.

Figure 2 Comparison of in-hospital mortality between higher LGI subgroup and lower LGI subgroup.

Figure 3 (A) The cumulative rate of MACCE on follow-up in AMI patients with diabetes. (B) The cumulative rate of MACCE on follow-up in AMI patients without diabetes.

Table 4 Cox Regression Analysis Results for MACCE on Follow-Up

	Diabetic Patients	p-value for Trend (Adjusted)	Non-Diabetic Patients	p-value for Trend (Adjusted)
	Adjusted HR (95% CI)		Adjusted HR (95% CI)
Gender	1.486(0.784, 2.817)	0.225	0.533(0.186, 1.528)	0.242
Age	1.051(1.020, 1.084)	0.001	1.046(1.009, 1.084)	0.014
STEMI vs NSTEMI	1.318(0.699, 2.486)	0.394	1.509(0.643, 3.537)	0.344
Killip class≥2	1.395(0.736, 2.644)	0.307	2.118(0.877, 5.118)	0.095
Heart rate	1.002(0.989, 1.016)	0.750	1.015(0.995, 1.035)	0.150
CRP	–	–	1.005(0.998, 1.013)	0.171
BNP	–	–	1.000(1.000, 1.000)	0.930
Serum creatinine	1.001(0.996, 1.006)	0.639	1.000(0.994, 1.007)	0.976
Uric acid	1.002(1.000, 1.005)	0.071	1.001(0.998, 1.005)	0.514
Higher LGI	1.978(0.916, 4.269)	0.082	2.540(1.076, 5.997)	0.033
PCI	0.489(0.250, 0.953)	0.036	0.221(0.091, 0.535)	0.001

Abbreviations: STEMI, ST-segment elevation myocardial infarction; NSTEMI, non-ST-elevation myocardial infarction; CRP, C-reactive protein; BNP, brain natriuretic polypeptide; LGI, leuko-glycemic index; PCI, percutaneous coronary intervention.