Association of the hsCRP–Glycemia Index with Coronary Artery Occlusion in Diabetic Patients with STEMI
TL;DR
The hs-CRP–glycemia index (CRPGI) is associated with angiographically confirmed total coronary artery occlusion in diabetic patients with STEMI, and it may represent a clinically relevant marker accompanying and potentially reflecting the extent of coronary occlusion at the time of presentation.
Abstract
Background and Objectives: The coexistence of elevated hs-CRP levels and diabetes mellitus may play an important role in plaque destabilization, favoring plaque rupture and thrombosis, and consequently increasing the risk of coronary artery occlusion and acute coronary syndrome. In this study, we aimed to assess the association of the CRP–glycemia index with coronary artery occlusion at presentation in diabetic patients with ST-segment elevation myocardial infarction (STEMI) and evaluate its potential role as a marker of angiographically confirmed total occlusion. Materials and Methods: In total, 131 consecutive patients presenting with ST-segment elevation myocardial infarction (STEMI) within 12 h of symptom onset who underwent percutaneous coronary intervention (PCI) were included in this study. At patient admission, laboratory assessments were performed, including creatine kinase (CK), CK-MB, troponin I, high-sensitivity C-reactive protein (hs-CRP), glucose, blood urea nitrogen (BUN), creatinine, cholesterol, and standard biochemical parameters. The hs-CRP–glycemia index (CRPGI) was calculated using the following formula: CRPGI = CRP (mg/L) × glucose (mmol/L). Based on the presence of coronary artery occlusion, patients were stratified into two groups: those with acute coronary syndrome and total coronary artery occlusion (ACS/CA–total occlusion (TO), Group 1) and those with ACS and non-total coronary artery occlusion (ACS/CA–non-total occlusion (nTO), Group 2). Results: Of the 131 diabetic patients with STEMI who were treated with PCI, 77 (58.78%) had ACS/CA-TO (Group 1), while 54 (41.22%) had ACS/CA-nTO (Group 2). The CRPGI differed significantly between the groups, p < 0.0001. Significant differences were also observed in glucose, hs-CRP levels, CK, CK-MB, troponin I, and ejection fraction (EF) (p = 0.011, p < 0.0001, p < 0.0001, p < 0.0001, p = 0.004, and p < 0.0001, respectively). Based on binary logistic regression analysis, glucose, and hs-CRP were significantly associated with coronary occlusion, with ORs of 1.115 (p = 0.027), and 1.114 (p < 0.0001), respectively. In the model incorporating the CRPGI, this index was also significantly associated with coronary occlusion (OR, 1.001; 95% CI, 1.000–1.001; p < 0.006). ROC analysis demonstrated the good discriminatory ability of CRPGI, with an AUC of 0.87 (95% CI, 0.80–0.93) and an exploratory optimal threshold of 201.49 (p < 0.0001). Conclusions: The hs-CRP–glycemia index (CRPGI) is associated with angiographically confirmed total coronary artery occlusion in diabetic patients with STEMI, and it may represent a clinically relevant marker accompanying and potentially reflecting the extent of coronary occlusion at the time of presentation.