Int J Angiol
DOI: 10.1055/s-0043-1771251
Original Article

The Relationship between Acute-to-Chronic Glycemic Ratio and SYNTAX Score in Diabetic Patients Presenting with Acute Coronary Syndrome

1   Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
1   Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
› Author Affiliations


A new index called the acute-to-chronic (A/C) glycemic ratio has been proposed to better represent the true acute glycemic rise in people with acute disease. However, there has been no previous study investigating the relationship between A/C glycemic ratio and SYNTAX score in patients with diabetic acute coronary syndrome (ACS). The aim of this study is to evaluate the role of A/C glycemic ratio in predicting coronary artery disease severity and SYNTAX score in diabetic patients presenting with ACS. The study included 131 consecutive patients hospitalized for ACS in our hospital, previously diagnosed with diabetes and undergoing percutaneous coronary intervention. The relationship between A/C glycemic ratio and SYNTAX score calculated at the time of admission was determined in univariate and multivariate linear regression analyses. The sample size was divided into three parts (T1, T2, and T3) according to the admission blood glucose (ABG)/estimated average glucose (eAG) ratio. When ABG/eAG and SYNTAX scores were compared, there was no significant difference between the T1 and T2 groups, but a significant increase was found in the T3 group compared with the other two groups (T1: 14.26, T2: 14.77, T3: 24.41; p < 0.001). When multivariate modeling was performed with the two or three most relevant variables (age, estimated glomerular filtration rate [eGFR], and ABG/eAG ratio), the upper tertile of the ABG/eAG variable was correlated with the severity of coronary atherosclerosis and higher SYNTAX score. This study shows that there is a significant relationship between higher ABG/eAG ratio and higher SYNTAX score in diabetic patients presenting with ACS.

Publication History

Article published online:
15 July 2023

© 2023. International College of Angiology. This article is published by Thieme.

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  • References

  • 1 GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388 (10053): 1459-1544
  • 2 Petersen JL, Mahaffey KW, Becker RC. et al. Coordinated series of studies to evaluate characteristics and mechanisms of acute coronary syndromes in high-risk patients randomly assigned to enoxaparin or unfractionated heparin: design and rationale of the SYNERGY Library. Am Heart J 2004; 148 (02) 269-276
  • 3 Kaya A, Kurt M, Tanboga IH. et al. Relation of neutrophil to lymphocyte ratio with the presence and severity of stable coronary artery disease. Clin Appl Thromb Hemost 2014; 20 (05) 473-477
  • 4 Maleki M, Tajlil A, Separham A. et al. Association of neutrophil to lymphocyte ratio (NLR) with angiographic SYNTAX score in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). J Cardiovasc Thorac Res 2021; 13 (03) 216-221
  • 5 Oswald GA, Corcoran S, Yudkin JS. Prevalence and risks of hyperglycaemia and undiagnosed diabetes in patients with acute myocardial infarction. Lancet 1984; 1 (8389): 1264-1267
  • 6 Ishihara M, Kagawa E, Inoue I. et al. Impact of admission hyperglycemia and diabetes mellitus on short- and long-term mortality after acute myocardial infarction in the coronary intervention era. Am J Cardiol 2007; 99 (12) 1674-1679
  • 7 Eitel I, Hintze S, de Waha S. et al. Prognostic impact of hyperglycemia in nondiabetic and diabetic patients with ST-elevation myocardial infarction: insights from contrast-enhanced magnetic resonance imaging. Circ Cardiovasc Imaging 2012; 5 (06) 708-718
  • 8 Planer D, Witzenbichler B, Guagliumi G. et al. Impact of hyperglycemia in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: the HORIZONS-AMI trial. Int J Cardiol 2013; 167 (06) 2572-2579
  • 9 Stranders I, Diamant M, van Gelder RE. et al. Admission blood glucose level as risk indicator of death after myocardial infarction in patients with and without diabetes mellitus. Arch Intern Med 2004; 164 (09) 982-988
  • 10 Worthley MI, Holmes AS, Willoughby SR. et al. The deleterious effects of hyperglycemia on platelet function in diabetic patients with acute coronary syndromes mediation by superoxide production, resolution with intensive insulin administration. J Am Coll Cardiol 2007; 49 (03) 304-310
  • 11 Williams SB, Goldfine AB, Timimi FK. et al. Acute hyperglycemia attenuates endothelium-dependent vasodilation in humans in vivo. Circulation 1998; 97 (17) 1695-1701
  • 12 Krinsley JS, Egi M, Kiss A. et al. Diabetic status and the relation of the three domains of glycemic control to mortality in critically ill patients: an international multicenter cohort study. Crit Care 2013; 17 (02) R37
  • 13 Egi M, Bellomo R, Stachowski E. et al. The interaction of chronic and acute glycemia with mortality in critically ill patients with diabetes. Crit Care Med 2011; 39 (01) 105-111
  • 14 Roberts GW, Quinn SJ, Valentine N. et al. Relative hyperglycemia, a marker of critical illness: introducing the stress hyperglycemia ratio. J Clin Endocrinol Metab 2015; 100 (12) 4490-4497
  • 15 Marenzi G, Cosentino N, Milazzo V. et al. Prognostic value of the acute-to-chronic glycemic ratio at admission in acute myocardial infarction: a prospective study. Diabetes Care 2018; 41 (04) 847-853
  • 16 Gao S, Liu Q, Ding X, Chen H, Zhao X, Li H. Predictive value of the acute-to-chronic glycemic ratio for in-hospital outcomes in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. Angiology 2020; 71 (01) 38-47
  • 17 Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. Modification of Diet in Renal Disease Study Group. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 1999; 130 (06) 461-470
  • 18 Sianos G, Morel MA, Kappetein AP. et al. The SYNTAX score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 2005; 1 (02) 219-227
  • 19 Serruys PW, Morice MC, Kappetein AP. et al; SYNTAX Investigators. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009; 360 (10) 961-972
  • 20 Thygesen K, Alpert JS, Jaffe AS. et al; ESC Scientific Document Group. Fourth universal definition of myocardial infarction (2018). Eur Heart J 2019; 40 (03) 237-269
  • 21 American Diabetes Association. 2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes-2018 . Diabetes Care 2018; 41 (Suppl. 01) S13-S27
  • 22 Harrell FE. Regression Modeling Strategies with Applications to linear Models, Logistic Regression and Survival Analysis. Heidelberg: Springer; 2015: 25-572
  • 23 Collet J-P, Thiele H, Barbato E. et al; ESC Scientific Document Group. 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021; 42 (14) 1289-1367
  • 24 Sharma PK, Agarwal S, Ellis SG. et al. Association of glycemic control with mortality in patients with diabetes mellitus undergoing percutaneous coronary intervention. Circ Cardiovasc Interv 2014; 7 (04) 503-509
  • 25 Domingueti CP, Dusse LM, Carvalho Md, de Sousa LP, Gomes KB, Fernandes AP. Diabetes mellitus: the linkage between oxidative stress, inflammation, hypercoagulability and vascular complications. J Diabetes Complications 2016; 30 (04) 738-745
  • 26 Chen S, Shen Y, Liu YH. et al. Impact of glycemic control on the association of endothelial dysfunction and coronary artery disease in patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2021; 20 (01) 64
  • 27 Monnier L, Mas E, Ginet C. et al. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA 2006; 295 (14) 1681-1687
  • 28 Baranyai T, Nagy CT, Koncsos G. et al. Acute hyperglycemia abolishes cardioprotection by remote ischemic perconditioning. Cardiovasc Diabetol 2015; 14: 151
  • 29 David RB, Almeida ED, Cruz LV. et al. Diabetes mellitus and glucose as predictors of mortality in primary coronary percutaneous intervention. Arq Bras Cardiol 2014; 103 (04) 323-330
  • 30 Zhang JW, Zhou YJ, Cao SJ, Yang Q, Yang SW, Nie B. Impact of stress hyperglycemia on in-hospital stent thrombosis and prognosis in nondiabetic patients with ST-segment elevation myocardial infarction undergoing a primary percutaneous coronary intervention. Coron Artery Dis 2013; 24 (05) 352-356
  • 31 Ekici B, Tanındı A, Sayın I. Effects of glomerular filtration rate on the severity of coronary heart disease. Turk Kardiyol Dern Ars 2016; 44 (02) 123-129
  • 32 Cay S, Metin F, Korkmaz S. Association of renal functional impairment and the severity of coronary artery disease. Anadolu Kardiyol Derg 2007; 7 (01) 44-48