The leuko-glycemic index can predict multivessel disease in the elderly acute myocardial infarction population? a retrospective cohort study

Aims: Cardiovascular diseases are still the leading cause of death, as the cause of approximately 30% of all deaths in the world and half of all deaths due to cardiovascular diseases also consist of individuals aged 70 and older. The leukoglycemic index (LGI) is a new parameter associated with mortality, complication, and prognosis in cardiovascular diseases. It can be applied easily at the bedside, has a low cost, and consists of a combination of leukocytes and glucose. In our study, we aimed to evaluate the predictive effect of leukoglycemic index on multivessel disease in elderly patients over 65 who were hospitalized with acute myocardial infarction. Methods: In our retrospective cohort study, patients over 65 who were hospitalized with the diagnosis of acute myocardial infarction were included. LGI was calculated with the formula: blood glucose × white blood cell/1000. All datas about patients were collected from the electronic hospital information system, patient files and our hospital’s archive. Results: The patients were divided into two groups: single-vessel disease and multivessel disease. The laboratory parameters of the patients were compared, and LGI (1532.5 (577.7-3770.3) vs 2077.9 (646.6-5301); p<0.001) were found to be significantly different between the two groups. According to unadjusted univariate log regression analysis, LGI was statistically significant in predicting multivessel disease (OR: 1.724, 95% CI: (1.222-2.432), p=0.002). After adjusting the model by adding clinically and statistically significant variables, LGI remained an independent predictor of multivessel disease (OR: 1.599, 95% CI (1.086-2.357), p=0.018). The discrimination ability of LGI was analyzed with ROC curve analysis. The LGI AUC value was 0.619 (95% Cl, 0.544-0.695, p=0.003). Conclusion: Our study showed that high LGI is an independent predictor of multivessel coronary artery disease in elderly patients with acute myocardial infarction.

Keywords:

Blood glucose, coronary artery disease, elderly, leukocyte myocardial infarction,

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İkitimur B. Yaşlılarda koroner arter hastalığına yaklaşım. Turk Kardiyol Dern Ars. 2017;45(5):32-34.
Gadó K, Szabo A, Markovics D, Virág A. Most common cardiovascular diseases of the elderly-a review article. Develop Health Sci. 2022;4(2):27-32.
Manfredi G, Midão L, Paúl C, Cena C, Duarte M, Costa E. Prevalence of frailty status among the European elderly population: Findings from the Survey of Health, Aging and Retirement in Europe. Geriatr Gerontol Int. 2019;19(8):723-729.
Sadeghi R, Roshdi Dizaji S, Vazirizadeh-Mahabadi M, Sarveazad A, Forouzannia SA. Prognostic value of the leuko-glycemic index in acute myocardial infarction; a systematic review and meta-analysis. Arch Acad Emerg Med. 2023;11(1):e25.
Qi LY, Liu HX, Cheng LC, et al. Prognostic value of the leuko-glycemic index in acute myocardial infarction patients with or without diabetes. Diabetes Metab Syndr Obes. 2022;1725-1736.
Kilic O, Buber I, Kahraman F. Predicting the severity of coronary artery disease: can the leukocyte glucose index be used? J Coll Physicians Surg Pak. 2022; 32(12):1519-1523.
Quiroga W, Conci E, Zelaya F, Isa M, Pacheco G, Sala J. Estratificación del riesgo en el infarto agudo de miocardio según el índice leucoglucémico.¿ El Killip-Kimball de laboratorio. Rev Fed Arg Cardiol. 2010;39(1):29-34.
Menon V, Lessard D, Yarzebski J, Furman MI, Gore JM, Goldberg RJ. Leukocytosis and adverse hospital outcomes after acute myocardial infarction. Am J Cardiol. 2003;92(4):368-372.
Furman MI, Gore JM, Anderson FA, et al. Elevated leukocyte count and adverse hospital events in patients with acute coronary syndromes: findings from the Global Registry of Acute Coronary Events (GRACE). Am Heart J. 2004;147(1):42-48.
Madjid M, Fatemi O. Components of the complete blood count as risk predictors for coronary heart disease: in-depth review and update. Tex Heart Inst J. 2013;40(1):17.
Weissberg PL, Bennett MR. Atherosclerosis--an inflammatory disease. N Engl J Med. 1999;340(24):1928-1929.
Ates AH, Canpolat U, Yorgun H, et al. Total white blood cell count is associated with the presence, severity and extent of coronary atherosclerosis detected by dual-source multislice computed tomographic coronary angiography. Cardiol J. 2011;18(4):371-377.
Kim JH, Lim S, Park KS, Jang HC, Choi SH. Total and differential WBC counts are related with coronary artery atherosclerosis and increase the risk for cardiovascular disease in Koreans. PLoS One. 2017;12(7):e0180332.
Deckers JW, van Domburg RT, Akkerhuis M, Nauta ST. Relation of admission glucose levels, short-and long-term (20-year) mortality after acute myocardial infarction. Am J Cardiol. 2013;112(9):1306-1310.
Kewcharoen J, Ali M, Trongtorsak A, Mekraksakit P, Vutthikraivit W, Kanjanauthai S. Admission hyperglycemia is associated with reperfusion failure in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis. Am J Cardiovasc Dis. 2021;11(3):348-359.
Terlecki M, Bednarek A, Kawecka-Jaszcz K, Czarnecka D, Bryniarski L. Acute hyperglycaemia and inflammation in patients with ST segment elevation myocardial infarction. Kardiologia Polska (Polish Heart J). 2013;71(3):260-267.
Alavi-Moghaddam M, Parsa-Mahjoob M, Ghodssi-Ghassemabadi R, Bitazar B. Association of admission blood glucose level with major adverse cardiac events in acute coronary syndrome; a cohort study. Arch Acad Emerg Med. 2019;7(1):e26.
Ishihara M, Kojima S, Sakamoto T, et al. Japanese Acute Coronary Syndrome Study (JACCS) Investigators: Comparison of blood glucose values on admission for acute myocardial infarction in patients with versus without diabetes mellitus. Am J Cardiol. 2009;104(6):769-774.
Bergmark BA, Mathenge N, Merlini PA, Lawrence-Wright MB, Giugliano RP. Acute coronary syndromes. The Lancet. 2022;399(10332):1347-1358.
Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28-292.
Veerasamy M, Bagnall A, Neely D, Allen J, Sinclair H, Kunadian V. Endothelial dysfunction and coronary artery disease. Cardiol Rev. 2015;23(3):119-129.
Zimbardo G, Cialdella P, Di Fusco P, Donahue ME, D’Aquino UML, Paolucci L, et al. Acute coronary syndromes and multivessel coronary artery disease. Eur Heart J Suppl. 2023;25(Supplement_C):C74-8.
Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Kardiologia Polska (Polish Heart J). 2016;74(9):821-936.
Saunderson CE, Brogan RA, Simms AD, Sutton G, Batin PD, Gale CP. Acute coronary syndrome management in older adults: guidelines, temporal changes and challenges. Age Ageing. 2014;43(4):450-455. doi:10.1093/ageing/afu034
Mehta RH, Rathore SS, Radford MJ, Wang Y, Wang Y, Krumholz HM. Acute myocardial infarction in the elderly: differences by age. J Am Coll Cardiol. 2001;38(3):736-741.
Derek Y, Hawkes C, Gould L, Hofman K. The global burden of chronic diseases. JAMA. 2004;291(21):2616-2622.
Lye M, Donnellan C. Heart disease in the elderly. Heart. 2000;84(5):560-566.
Lakatta EG. Age-associated cardiovascular changes in health: impact on cardiovascular disease in older persons. Heart Fail Rev. 2002;7(1):29-49.
Kochar A, Chen AY, Sharma PP, et al. Long‐term mortality of older patients with acute myocardial infarction treated in US clinical practice. J Am Heart Assoc. 2018;7(13):e007230.
Avezum A, Makdisse M, Spencer F, et al. Impact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE). Am Heart J. 2005;149(1):67-73.
Sorajja P, Gersh BJ, Cox DA, et al. Impact of multivessel disease on reperfusion success and clinical outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Eur Heart J. 2007;28(14):1709-1716.
de Carvalho Cantarelli MJ, Castello Jr HJ, Gonçalves R, et al. Independent predictors of multivessel coronary artery disease: results from Angiocardio Registry. Revista Brasileira de Cardiologia Invasiva (English Edition). 2015;23(4):266-270.