Impact of Elevated Glucose Levels on Cardiac Function in STEMI Patients: Glucose Delta as a Prognostic Biomarker

Background Elevated glucose levels have emerged as a significant prognostic factor following acute myocardial infarction (AMI). Objective This study aimed to evaluate glycemic parameters associated with infarct size and left ventricular function. Research Design and Methods A total of 244 patients with ST-segment elevation myocardial infarction (STEMI) treated using a pharmacoinvasive strategy were included. Glucose delta was calculated as the difference between mean glucose levels estimated from glycated hemoglobin (HbA1c) and serum glucose levels collected at hospital admission. Infarct size and left ventricular ejection fraction (LVEF) were assessed 30 days post-infarction using cardiac magnetic resonance (CMR) imaging. Results Higher glucose delta values were significantly associated with reduced LVEF and larger infarct size, regardless of diabetes diagnosis. Differences in infarcted ventricular mass were noted between diabetic and non-diabetic patients above specific thresholds: (18.62 ± 11.0 g) vs. (16.24 ± 13.17 g), p = 0.019 , with an effect size of 0.55. The receiver operating characteristic curve yielded an area under the curve (AUC) of 0.65 (95% CI: 0.57–0.72). Conclusions In STEMI patients undergoing pharmacoinvasive treatment, a higher glycemic delta was associated with greater infarct size and lower LVEF. This straightforward glycemic parameter provides valuable prognostic insight for both diabetic and non-diabetic populations.