Impact of Glycemic Gap on Early Adverse Events in Thrombolysed STEMI Patients: A Risk-Adjusted Analysis

Background: ST-segment elevation myocardial infarction (STEMI) represents the most severe and urgent form of ischemic heart disease (IHD), resulting in significant illness and death.The purpose of the study is to assess the prognostic significance of glycemic gap in predicting early adverse outcomes among thrombolysed STEMI patients. Aim of the study:The aim of the study was to evaluate the prognostic significance of glycemic gap in predicting early adverse outcomes among thrombolysed STEMI patients using a risk-adjusted analytical approach.Methods: This cross-sectional observational study was conducted at the Department of Cardiology, Mymensingh Medical College Hospital, Bangladesh (October 2019-March 2021), including 287 first-onset STEMI patients thrombolysed with streptokinase within 12 hours.Participants were grouped by glycemic gap (>40 mg/dL vs. 40 mg/dL), calculated from admission glucose and HbA1c.Data included clinical assessment, ECGs, echocardiography, and labs.Outcomes were recorded.Analysis was done using SPSS v20.0; p < 0.05 was considered significant.Results: Among 287 thrombolysed STEMI patients, those with a glycemic gap >40 mg/dl (Group I) had higher rates of heart failure (60.2% vs. 28.3%),cardiogenic shock (35.2% vs. 17.8%), and mortality (13.3% vs. 5.7%) compared to those with 40 mg/dl (Group II).Group I also had significantly higher admission glucose, glycemic gap, and lower ejection fraction.Glycemic gap was an independent predictor of heart failure in both unadjusted (OR 7.84, p = 0.005) and adjusted (OR 2.75, p = 0.007) models. Conclusion:A higher glycemic gap independently predicts early in-hospital adverse outcomes, including heart failure, in thrombolysed STEMI patients.