Association of Glycemic Gap with In-Hospital Adverse Outcome after First Attack of Acute ST Elevation Myocardial Infarction in Thrombolysed Patients.

Stress-induced hyperglycemia (SIH), reflected by an elevated glycemic gap, has been associated with poor outcomes in acute coronary syndromes. This study aimed to evaluate the association between glycemic gap and in-hospital adverse outcomes in patients experiencing their first attack of acute ST-elevation myocardial infarction (STEMI) who were managed with thrombolytic therapy. This cross-sectional comparative study was conducted at Mymensingh Medical College Hospital, Mymensingh, Bangladesh from October 2019 to March 2021. In this study 287 first-time STEMI patients were included who underwent thrombolysis. Total patients were divided into two groups based on glycemic gap: Group I (>40mg/dL) and Group II (≤40mg/dL). The mean age in Group I and Group II was 55.36±13.28 and 53.06±11.64 years respectively. Males predominated in both groups. Hypertension, diabetes mellitus and sedentary lifestyle were significantly more prevalent in Group I. Admission blood glucose and glycemic gap were significantly higher in Group I (p<0.001). In-hospital complications were significantly more common in Group I, including heart failure (60.2% vs. 28.3%, p<0.001), cardiogenic shock (35.16% vs. 17.75%, p<0.01) and mortality (13.28% vs. 5.66%, p<0.05). Multivariate analysis identified elevated glycemic gap as an independent predictor of heart failure (OR=2.746; 95% CI: 1.060-2.657; p=0.007). This study found that a high glycemic gap is significantly associated with adverse in-hospital outcomes in first-time STEMI patients treated with thrombolysis, suggesting it's potential as a useful prognostic marker for identifying high-risk individuals who require closer care.