Association of inflammatory markers and poor outcome in diabetic patients presenting with ST segment elevation myocardial infarction

Figures & data

Table 1 Clinical and medical history data of the STEMI patients (n=601)

Parameters
Female sex, n (%)	226 (37.61)
Age, years	62.90 (61.99; 63.81)
Smoking, n (%)	241 (40.09)
Arterial hypertension, n (%)	537 (89.35)
Diabetes mellitus, n (%)	140 (23.29)
Impaired glucose tolerance, n (%)	32 (5.32)
History of myocardial infarction, n (%)	166 (27.62)
History of angina pectoris, n (%)	354 (58.90)
History of stroke, n (%)	64 (10.64)
Obesity (BMI >25 kg/m^2), n (%)	427 (71.04)
Left ventricular ejection fraction, %	48.97 (48.11; 49.84)
LV dysfunction (LVEF <46%), n (%)	161 (26.78)
Killip class upon admission (II–IV), n (%)	123 (20.46)
Mean TIMI score	3.94 (3.71; 4.16)
Coronary angiography, n (%)	436 (72.54)
Reperfusion, n (%)
Stenting	301 (50.08)
Balloon angioplasty	75 (12.47)
Intracoronary TLT	14 (2.32)
Hospital medications, n (%)
Antiplatelets	567 (94.34)
β-blockers	509 (84.69)
ACE inhibitors	510 (84.85)
Diuretics	240 (39.93)
Statins	152 (25.29)
Calcium channel blockers	395 (65.72)

Notes: The values given in the brackets are the median (Q1;Q3).

Abbreviations: ACE, angiotensin-converting-enzyme inhibitor; BMI, body mass index; LV, left ventricular; LVEF, left ventricular ejection fraction; STEMI, ST segment elevationmyocardialinfarction; TIMI, Thrombolysis in Myocardial Infarction; TLT, thrombolytic therapy.

Table 2 Clinical and medical history data of the STEMI patients with regard to carbohydrate metabolism disorders

Parameters	Normal glucosea (n=429)	DMb (n=140)	IGTc (n=32)	P-value
Mean age, years	61.0 (53.0; 72.0)	66.0 (58.0; 71.0)	59.5 (54.0; 69.0)	P=0.106a,b P=0.304a,c P=0.027b,c
Female sex, n (%)	123 (28.67)	86 (61.42)	17 (53.12)	P≤0.001a,b P=0.007a,c P=0.506b,c
Arterial hypertension, n (%)	375 (87.41)	133 (95.0)	29 (90.62)	P=0.018a,b P=0.592a,c P=0.799b,c
Obesity, n (%)	282 (65.73)	116 (87.22)	29 (90.62)	P≤0.001a,b P=0.027a,c P=0.819b,c
History of MI, n (%)	104 (24.24)	52 (37.14)	10 (31.25)	P=0.004a,b P=0.500a,c P=0.673^Citation2,Citation3
History of angina pectoris, n (%)	229 (53.37)	103 (73.57)	22 (68.75)	P≤0.001a,b P=0.134a,c P=0.740b,c
History of CHF, n (%)	27 (6.29%)	14 (10.0%)	3 (9.37%)	P=0.027a,b P=0.673a,c P=0.506b,c
History of stroke, n (%)	36 (8.39)	21 (15.0)	7 (21.87)	P=0.036a,b P=0.027a,c P=0.493b,c
Smoking, n (%)	188 (43.82)	31 (22.14)	22 (68.75)	P≤0.001a,b P=0.011a,c P≤0.001b,c
LVEF, %	50.0 (43.0–56.0)	49.0 (44.0–55.0)	48.50 (40.0–55.50)	P=0.535a,b P=0.734a,c P=0.983b,c
LV dysfunction (LVEF <46%), n (%)	136 (31.70)	41 (29.29)	10 (31.25)	P=0.666a,b P=0.960a,c P=0.996b,c
MI localization, n (%)
Anterior MI	205 (47.79)	70 (50.0)	19 (59.38)	P=0.006a,b
Posterior MI	200 (46.62)	55 (39.29)	13 (40.62)	P=0.416a,c
Posterior MI with the right	10 (2.33)	1 (0.71)	0 (0)	P=0.274b,c
ventricle affected
Circular MI	14 (3.26)	414 (10.0)	0 (0)
Killip class upon admission, n (%)
I	331 (77.16)	90 (64.29)	20 (62.50)	P≤0.001a,b
II	70 (16.32)	22 (15.71)	10 (31.25)	P=0.109a,c
III	16 (3.73)	21 (15.0)	2 (6.25)	P=0.090b,c
IV	12 (2.79)	7 (5.0)	0 (0)
Mean TIMI score	3.0 (2.0; 6.0)	4.0 (2.0; 6.0)	3.5 (2.0; 6.0)	P=0.184a,b P=0.934a,c P=0.857b,c
SYNTAX	17.65 (15.34; 20.05)	21.04 (17.56; 23.78)	18.22 (15.82; 22.15)	P=0.262a,b P=0.653a,c P=0.506b,c

Notes:

a group with normal glucose.

b group with diabetes mellitus.

c group with impaired glucose tolerance.

Abbreviations: CHF, congestive heart failure; DM, diabetes mellitus; IGT, impaired glucose tolerance; LV, left ventricular; LVEF, left ventricular ejection fraction; MI, myocardial infarction; STEMI, ST segment elevation myocardial infarction; TIMI, Thrombolysis in Myocardial Infarction.

Table 3 Main characteristics of hospital coronary interventions for the STEMI patients with regard to carbohydrate metabolism disorders

Parameters	Normal glucosea (n=429)	DMb (n=140)	IGTc (n=32)	P-value
Coronary angiography, n (%)	309 (72.03)	104 (74.29)	23 (71.87)	P=0.681a,b P=0.960a,c P=0.955b,c
PCI, n (%)	274 (63.87)	79 (56.43)	20 (62.50)	P=0.140a,b P=0.960a,c P=0.668b,c
Stenting, n (%)	219 (51.05)	66 (47.14)	16 (50.0)	P=0.481a,b P=0.960a,c P=0.924b,c
Balloon angioplasty, n (%)	58 (13.52)	12 (8.57)	5 (15.62)	P=0.162a,b P=0.946a,c P=0.380b,c
TLT, n (%)
Systemic	35 (8.16)	11 (7.86)	3 (9.38)	P=0.729a,b
Intracoronary	11 (2.56)	2 (1.43)	1 (3.12)	P=0.951a,c P=0.766b,c

Notes:

a group with normal glucose.

b group with diabetes mellitus.

c group with impaired glucose tolerance.

Abbreviations: DM, diabetes mellitus; IGT, impaired glucose tolerance; PCI, percutaneous coronary intervention; STEMI, ST segment elevation myocardial infarction; TLT, thrombolytic therapy.

Table 4 Hospital outcome of the STEMI patients with regard to carbohydrate metabolism disorders

Parameters	Normal glucosea (n=429)	DMb (n=140)	IGTc (n=32)	P-value
Composite hospital end points, n (%)	81 (18.88)	36 (25.71)	7 (21.87)	P=0.106a,b P=0.855a,c P=0.821b,c
Hospital death, n (%)	42 (9.79)	15 (10.71)	2 (6.25)	P=0.878a,b P=0.730a,c P=0.663b,c
Restenosis/rethrombosis, n (%)	15 (3.50)	16 (11.43)	2 (6.25)	P=0.001a,b P=0.756a,c P=0.587b,c
Early postinfarction angina, n (%)	23 (5.36)	15 (10.71)	3 (9.37)	P=0.045a,b P=0.581 a,c P=0.960b,c
Recurrent in-hospital MI, n (%)	26 (6.06)	19 (13.57)	4 (12.50)	P=0.007a,b P=0.292a,c P=0.960b,c
Stroke, n (%)	1 (0.23)	0 (0)	0 (0)	P=0.960a,b P=0.960a,c P=0.960b,c

Notes:

a group with normal glucose.

b group with diabetes mellitus.

c group with impaired glucose tolerance.

Abbreviations: DM, diabetes mellitus; IGT, impaired glucose tolerance; MI, myocardial infarction; STEMI, ST segment elevation myocardial infarction.

Table 5 End points within 1 year after STEMI with regard to carbohydrate metabolism disorders (n=470)

End points	Normal glucosea (n=429)	DMb (n=140)	IGTc (n=32)	P-value
Composite end point, n (%)	92 (28.84)	52 (43.70)	11 (36.67)	P=0.005a,b P=0.491a,c P=0.624b,c
Death, n (%)	39 (12.22)	18 (15.12)	2 (6.67)	P=0.520a,b P=0.544a,c P=0.360b,c
MI, n (%)	49 (15.36)	31 (26.05)	6 (20.0)	P=0.015a,b P=0.686a,c P=0.653b,c
Stroke, n (%)	8 (2.50)	9 (7.56)	1 (3.33)	P=0.031a,b P=0.960a,c P=0.675b,c
Unstable angina, n (%)	29 (9.09)	18 (15.13)	5 (16.67)	P=0.101a,b P=0.310a,c P=0.960b,c
CHF worsening, n (%)	10 (3.14)	9 (7.56)	1 (3.33)	P=0.078a,b P=0.960a,c P=0.675b,c
Emergency PCI, n (%)	18 (5.64)	16 (13.45)	6 (20.0)	P=0.012a,b P=0.009a,c P=0.538b,c

Notes:

a group with normal glucose.

b group with diabetes mellitus.

c group with impaired glucose tolerance.

Abbreviations: CHF, congestive heart failure; DM, diabetes mellitus; IGT, impaired glucose tolerance; MI, myocardial infarction; PCI, percutaneous coronary intervention; STEMI, ST segment elevation myocardial infarction.

Table 6 One-year outcome in the groups with regard to PCI and IGT

1-year outcomes	No PCI		PCI		P-value
	Carbohydrate metabolism disorders	Normal blood glucose	Carbohydrate metabolism disorders	Normal blood glucose
Good outcome, %	51.56	54.26	63.22	78.22	≤0.001* ≤0.001**
Poor outcome, %	48.44	45.74	36.78	21.28	≥0.05

Notes:

* significant differences between normal blood glucose (PCI) and carbohydrate metabolism disorders (PCI).

** Significant differences between normal blood glucose (no PCI) and normal blood glucose (PCI).

Abbreviations: IGT, impaired glucose tolerance; PCI, percutaneous coronary intervention.

Table 7 Inflammation markers in STEMI patients with regard to carbohydrate metabolism disorders

Inflammation markers	Normal glucosea (n=429)	DMb (n=140)	IGTc (n=32)	P-value
Fibrinogen, g/L	3.2 (2.58; 4.2)	3.75 (2.84; 6.05)	3.5 (2.34; 5.08)	P=0.005a,b P=0.493a,c P=0.308b,c
TNF-α, pg/mL	9.61 (7.24; 11.99)	9.32 (6.16; 13.68)	9.75 (7.05; 12.79)	P=0.871a,b P=0.534a,c P=0.727b,c
IL-10, pg/mL	1.78 (1.06; 2.72)	2.13 (1.22; 3.31)	1.98 (1.15; 3.05)	P=0.528a,b P=0.204a,c P=0.215b,c
IL-8, pg/mL	3.35 (1.65; 5.73)	3.24 (1.88; 5.84)	3.53 (1.74; 5.96)	P=0.810a,b P=0.450a,c P=0.376b,c
IL-6, pg/mL	2.05 (0.44; 5.68)	4.75 (0.79; 7.46)	3.97 (0.56; 6.49)	P=0.023a,b P=0.039a,c P=0.278b,c
IL-12, pg/mL	99.0 (64.07; 120.3)	109.50 (95.63; 128.0)	122.5 (107.30; 133.50)	P=0.152a,b P=0.017a,c P=0.032b,c
CRP, mg/L	11.95 (6.57; 19.75)	13.10 (5.52; 18.0)	12.03 (5.47; 17.56)	P=0.687a,b P=0.785a,c P=0.432b,c
sCD40l, ng/mL	4.85 (2.16; 8.42)	8.30 (5.77; 10.44)	7.87 (3.55; 9.79)	P=0.031a,b P=0.045a,c P=0.308b,c

Notes: Values are presented as median (Q1:Q3).

a group with normal glucose.

b group with diabetes mellitus.

c group with impaired glucose tolerance.

Abbreviations: CRP, c-reactive protein; DM, diabetes mellitus; IGT, impaired glucose tolerance; IL, interleukin; sCD40L, CD40 ligand; STEMI, ST segment elevation myocardial infarction; TNF, tumor necrosis factor; Q, interquartile range.

Table 8 Factors associated with poor 1-year outcome

Parameters	Odds ratio	95% CI	P-value
Normal glucose
Female-to-male ratio	1.97	1.17–3.31	0.008
Ratio of the patients older and younger than 70 years	3.77	2.24–6.35	<0.0001
History of MI	1.86	1.08–3.22	0.020
History of angina pectoris	2.02	1.23–3.32	0.007
History of stroke	2.67	1.11–6.39	0.009
LVEF <46%	3.81	2.26–6.45	<0.0001
Ratio of Killip II–IV and I	3.21	1.81–5.71	<0.0001
Admission glucose of >7.8 mmol/L	3.51	2.11–5.83	<0.0001
PCI	0.33	0.20–0.55	<0.0001
Recurrent in-hospital MI	3.20	0.84–7.21	0.029
TNF-α >14.12 pg/mL	4.73	1.93–11.58	0.0001
IL-6 >8.05 pg/mL	3.14	1.29–7.67	0.007
IL-12 >110.01 pg/mL	5.18	1.54–7.37	0.009
Diabetes mellitus
History of chronic heart failure	3.71	0.67–8.40	0.039
LVEF <46%	4.01	1.35–8.37	0.034
Ratio of Killip II–IV and I	3.51	1.31–7.05	0.041
PCI	0.23	0.15–0.69	0.039
IL-12 >110.01 pg/mL	5.57	1.01–9.34	0.033
Impaired glucose tolerance
History of angina pectoris	1.37	0.61–3.09	0.044
PCI	0.20	0.10–0.63	0.022
Admission glucose of >7.8 mmol/L	1.93	0.43–8.61	0.038
IL-12 >110.01 pg/mL	4.74	1.12–6.17	0.024

Abbreviations: CI, confidence interval; IL, interleukin; LVEF, left ventricular ejection fraction; MI, myocardial infarction; PCI, percutaneous coronary intervention; TNF, tumor necrosis factor.

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