Predictive value of glucose coefficient of variation for in-hospital mortality in acute myocardial infarction patients undergoing PCI: Insights from the MIMIC-IV database

Abstract

Background

Acute myocardial infarction (AMI) carries a high short-term risk of death, even after percutaneous coronary intervention (PCI). Glucose variability (GV), measured by the glucose coefficient of variation (GluCV), is a potential risk factor for adverse outcomes. This study investigates GluCV's predictive value for in-hospital mortality in AMI patients undergoing PCI.

Method

This study involved 2325 AMI patients who were admitted to the ICU and underwent PCI from the MIMIC-IV database. Patients were categorized into quartiles based on GluCV: <0.13, 0.13–0.20, 0.20–0.29, and ≥0.29. Multivariable logistic regression and Restricted cubic spline (RCS) analysis were employed to analyze the relationship between GluCV and in-hospital mortality. Mediation analysis was used to evaluate the role of GluCV in the relationship between disease complexity and severity.

Results

Among the 2325 patients, 203 (8.7 %) died during hospitalization. Higher GluCV was associated with increased in-hospital mortality. Adjusted odds ratios for mortality were 1.35 (95 % CI: 0.71–2.55), 1.91 (95 % CI: 1.04–3.51), and 3.32 (95 % CI: 1.83–6.02) for the second, third, and fourth groups, respectively. RCS analysis indicated a linear relationship between Log GluCV and mortality risk, with each 1 SD increase in Log GluCV associated with a 1.70-fold increase in mortality. Subgroup analysis showed a stronger relationship between GluCV and mortality in patients younger than 70. Mediation analysis indicated that GluCV partially mediates the effect of comorbidities on organ dysfunction.

Conclusions

GluCV is an important predictor of in-hospital mortality in AMI patients undergoing PCI. Managing GV to minimize fluctuations may improve patient prognosis.