Abstract: Background　Elevated levels of acute glycemia at hospital admission are common among patients with acute myocardial infarction（AMI）.It has been found that in clinical practice，AMI patients are often combined with a variety of complex clinical factors，which may cause acute hyperglycemia.Acute-to-chronic glycemic ratio may be a predictor of poor short-term prognosis in such patients，but relevant studies are still lacking in China.Objective　To study the relationship between acute-to-chronic glycemic ratio and poor short-term prognosis in patients with AMI.Methods　We enrolled 272 inpatients with ST-elevation and non-ST-elevation AMI from CCU，Guizhou Provincial People's Hospital between January 2017 and January 2018.The primary end point of the study was mortality within a 30-day follow-up.Venous plasma glycemia and glycosylated hemoglobin（HbA1c） levels were measured at hospital admission，then the chronic glycemia was estimated based on HbA1c，and acute-to-chronic glycemic ratio was calculated further.Factors associated with poor short-term prognosis were analyzed.The ROC curve of acute-to-chronic glycemic ratio in predicting poor short-term prognosis of AMI was plotted，and the optimal cutoff value was estimated.Kaplan-Meier method was used for survival analysis.The incidence of adverse cardiovascular events was explored by acute-to-chronic glycemic ratio.Results　By the survival status，the patients were divided into the survival group（n=256） and the death group （n=16）.Multivariate Logistic regression analysis showed that Killip classⅡ-Ⅲ，three-vessel coronary artery lesions and elevated acute-to-chronic glycemic ratio were independent risk factors associated with poor short-term prognosis（OR=23.110，0.073，35.885，P<0.05）.Patients were divided into acute-to-chronic glycemic ratio >1.01 group（n=138） and≤1.01 group（n=134）by the cutoff value，and the former group had much lower short-term cumulative survival rate（90.3% vs 97.8%）（χ2=6.932，P=0.008）showed by survival analysis.Further subgroup analysis by diabetes indicated that，those without diabetes and acute-to-chronic glycemic ratio >1.01 had a significantly reduced short-term cumulative survival rate compared with those with diabetes and acute-to-chronic glycemic ratio≤1.01（92.3% vs 97.5%）（χ2=4.465，P=0.035）those with diabetes and acute-to-chronic glycemic ratio >1.01 had a significantly reduced short-term cumulative survival rate compared with those with diabetes and acute-to-chronic glycemic ratio≤1.01（86.0% vs 100.0%）（χ2=5.658，P=0.017）.Acute pulmonary edema，cardiogenic shock，atrial tachycardia，and ventricular tachycardia were significantly increased in acute-to-chronic glycemic ratio >1.01 group （P<0.05）.Conclusion　 Elevated acute-to-chronic glycemic ratio is an independent risk factor for poor short-term prognosis in patients with AMI，and is closely related to adverse cardiovascular events.Elevated acute-to-chronic glycemic ratio is also associated with lower short-term cumulative survival rate and poorer short-term prognosis in AMI patients with or without diabetes.Its value is more valuable to predict the poor short-term prognosis in those with diabetes.Acute-to-chronic glycemic ratio >1.01 may be used as the optimal cutoff value to predict the poor short-term prognosis of patients with AMI.Above this level，cardiovascular adverse events may increase significantly and the short-term prognosis of patients may be poor.

Key words: Blood glucose；Hemoglobin A, glycosylated；Acute and chronic glycemia ratio；Myocardial infarction；Short-term poor prognosis；Prognosis

摘要： 背景　急性心肌梗死（AMI）患者入院时常存在急性血糖升高，在临床实践中发现，有多种复杂的临床因素可能引起急性血糖升高。急慢性血糖比值可能成为评估患者短期不良预后的预测因子，但目前国内尚缺乏相关研究。目的　探讨急慢性血糖比值与AMI患者不良心血管事件及短期不良预后的关系。方法　纳入2017年1月—2018年1月在贵州省人民医院CCU住院的AMI患者，包括ST段抬高型心肌梗死（STEMI）和非ST段抬高性心肌梗死（NSTEMI）患者共272例，进行30 d随访，终点事件是死亡。依据终点事件分为存活组和死亡组。患者住院即刻测量急性血糖（静脉血糖）和糖化血红蛋白（HbA1c）水平，依据HbA1c计算慢性血糖，并计算急慢性血糖比值。分析AMI患者短期不良预后的影响因素。绘制急慢性血糖比值预测AMI患者短期不良预后的ROC曲线，计算急慢性血糖比值的最佳截断值；应用Kaplan-Meier法绘制生存曲线，比较不同急慢性血糖比值分组患者不良心血管事件的发生情况。结果　存活组256例、死亡组16例。多因素Logistic回归分析显示，Killips分级Ⅱ~Ⅲ级、冠状动脉三支病变及急慢性血糖比值为AMI患者短期不良预后的独立危险因素（OR=23.110、0.073、35.885，P<0.05）。依据最佳截断值将患者分为急慢性血糖比值≤1.01组（n=138）和急慢性血糖比值>1.01组（n=134）。生存分析显示，急慢性血糖比值>1.01组的短期累积生存率（90.3%）低于急慢性血糖比值≤1.01组短期累积生存率（97.8%）（χ2=6.932，P=0.008）。进一步行非糖尿病及合并糖尿病患者的亚组分析显示，非糖尿病患者中，急慢性血糖比值>1.01亚组患者短期累积生存率（92.3%）低于急慢性血糖比值≤1.01亚组（97.5%）（χ2=4.465，P=0.035）；合并糖尿病的患者中，急慢性血糖比值>1.01亚组累积生存率（86.0%）低于急慢性血糖比值≤1.01亚组（100.0%）（χ2=5.658，P=0.017）。急慢性血糖比值>1.01组急性肺水肿、心源性休克、房性心动过速、室性心动过速发生率较急慢性血糖比值≤1.01组增加（P<0.05）。结论　急慢性血糖比值是反映AMI患者短期不良预后的独立危险因素，其水平与患者不良心血管事件有关。不论患者是否合并糖尿病，急慢性血糖比值较高时，患者累积生存率低，短期预后差；急慢性血糖比值对合并糖尿病患者的短期不良预后有预测价值。可将急慢性血糖比值>1.01作为预测AMI患者短期不良预后的最佳截断值，高于此水平不良心血管事件明显增加，且患者短期预后不良。

关键词: 血糖；血红蛋白A, 糖基化；急慢性血糖比值；心肌梗死；短期不良预后；预后