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Background <p>Admission dysglycemia is linked to adverse outcomes after ST-elevation myocardial infarction (STEMI); however, its relationship with early recovery of left ventricular (LV) function after primary percutaneous coronary intervention (PPCI), particularly when using stress-adjusted indices, remains uncertain in South Asian settings.</p> Objective <p>To evaluate whether admission glycemia (glucose and hemoglobin A1c [HbA1c]) and relative indices (stress hyperglycemia ratio [SHR] and glycemic gap) are independently associated with early improvement in LV ejection fraction (LVEF) and whether these associations persist at 30–90 days and align with early major adverse cardiovascular events (MACE).</p> Methods <p>A retrospective cohort of 600 consecutive STEMI patients undergoing PPCI (January 2023–December 2024) was stratified a priori into good, intermediate, or poor glycemic control. The primary outcome was follow-up LVEF within 7 days, modeled by analysis of covariance (ANCOVA) with baseline LVEF and clinical/angiographic covariates (heteroscedasticity-robust HC3 standard error). Sensitivity analyses included two-time-point mixed-effects models, continuous SHR/glycemic gap specifications (with splines), a non-diabetic subset, and adjustment for echocardiography timing.</p> Results <p>Early LVEF gains were greater with good control than with intermediate or poor control (mean change, 4.13% [SD, 4.78] vs. 2.15% (SD, 5.12) and 1.01% [5.45]; <i>p</i> &lt; 0.001). In adjusted analyses, follow-up LVEF was lower in intermediate vs good by −2.42% points (95% CI, −3.38 to −1.46) and in poor vs good by −3.74% points (95% CI, −4.76 to −2.71) (both <i>p</i> &lt; 0.001). Accordingly, early recovery declined stepwise with worsening admission glycemia, and the gradient persisted at 30 and 90 days in parallel with higher MACE across the strata. Accordingly, early recovery declined stepwise with worsening admission glycemia, and the gradient persisted at 30 and 90 days in parallel with higher MACE across the strata.</p> Conclusions <p>Admission dysglycemia, including stress-adjusted indices, was associated with attenuated early LVEF recovery after PPCI, with signals persisting through 90 days and aligning with early MACE. In practice, routine HbA1c-anchored stress-adjusted profiling at presentation may refine risk stratification and support protocolized inpatient glucose management.</p>

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From metabolism to myocardium: the missing link of admission dysglycemia in early cardiac recovery

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月7日

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  • Fahad Raja Khan,
  • Fazal Akbar,
  • Kamran Aslam

摘要

Background

Admission dysglycemia is linked to adverse outcomes after ST-elevation myocardial infarction (STEMI); however, its relationship with early recovery of left ventricular (LV) function after primary percutaneous coronary intervention (PPCI), particularly when using stress-adjusted indices, remains uncertain in South Asian settings.

Objective

To evaluate whether admission glycemia (glucose and hemoglobin A1c [HbA1c]) and relative indices (stress hyperglycemia ratio [SHR] and glycemic gap) are independently associated with early improvement in LV ejection fraction (LVEF) and whether these associations persist at 30–90 days and align with early major adverse cardiovascular events (MACE).

Methods

A retrospective cohort of 600 consecutive STEMI patients undergoing PPCI (January 2023–December 2024) was stratified a priori into good, intermediate, or poor glycemic control. The primary outcome was follow-up LVEF within 7 days, modeled by analysis of covariance (ANCOVA) with baseline LVEF and clinical/angiographic covariates (heteroscedasticity-robust HC3 standard error). Sensitivity analyses included two-time-point mixed-effects models, continuous SHR/glycemic gap specifications (with splines), a non-diabetic subset, and adjustment for echocardiography timing.

Results

Early LVEF gains were greater with good control than with intermediate or poor control (mean change, 4.13% [SD, 4.78] vs. 2.15% (SD, 5.12) and 1.01% [5.45]; p < 0.001). In adjusted analyses, follow-up LVEF was lower in intermediate vs good by −2.42% points (95% CI, −3.38 to −1.46) and in poor vs good by −3.74% points (95% CI, −4.76 to −2.71) (both p < 0.001). Accordingly, early recovery declined stepwise with worsening admission glycemia, and the gradient persisted at 30 and 90 days in parallel with higher MACE across the strata. Accordingly, early recovery declined stepwise with worsening admission glycemia, and the gradient persisted at 30 and 90 days in parallel with higher MACE across the strata.

Conclusions

Admission dysglycemia, including stress-adjusted indices, was associated with attenuated early LVEF recovery after PPCI, with signals persisting through 90 days and aligning with early MACE. In practice, routine HbA1c-anchored stress-adjusted profiling at presentation may refine risk stratification and support protocolized inpatient glucose management.