Low estimated glucose disposal rate predicts high residual syntax score in non-diabetic ST-elevation myocardial infarction patients.

BACKGROUND AND AIM: Insulin resistance (IR) plays a significant role in the development of cardiovascular disease (CVD), even in non-diabetic individuals, with a 46% higher likelihood of coronary artery disease (CAD) for each 1 SD increase in IR. The estimated glucose disposal rate (eGDR) is a validated marker for IR. However, its association with the residual SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score (rSS), which assesses residual stenosis severity after percutaneous coronary intervention (PCI), has not been investigated in non-diabetic ST-segment elevation myocardial infarction (STEMI) patients. This study aims to explore the relationship between eGDR and rSS in non-diabetic STEMI patients undergoing PCI. METHODS: This single-center observational study enrolled 390 non-diabetic STEMI patients who underwent PCI. The complexity of CAD was assessed pre-PCI using the SYNTAX score, and post-PCI, the rSS was calculated. eGDR was derived using waist circumference, HbA1c, and hypertension status, based on a previously validated equation. The association between eGDR and rSS was analyzed using multivariable logistic regression. The optimal eGDR cut-off value for predicting higher rSS was determined using Youden's index. RESULTS: The cohort had a mean age of 58.74 ± 9.01 years and was predominantly male (76.66%). Participants were divided into lower and higher eGDR groups based on the median eGDR value of 7.74. Multivariable logistic regression identified lower eGDR as an independent predictor of higher rSS (adjusted OR = 1.84, 95% CI: 1.59-2.14, p < 0.001), after adjusting for demographic, clinical, and metabolic factors. The association remained consistent in a secondary model that included additional anatomical and procedural variables (adjusted OR = 1.81; p < 0.001; 95% CI: 1.37-2.39).The optimal eGDR cut-off value for predicting high rSS was 7.04 (AUC: 0.803, 95% CI: 0.747-0.882, p < 0.001), with a sensitivity of 76.04% and specificity of 73.20%. CONCLUSION: eGDR, is an independent predictor of higher rSS in non-diabetic patients undergoing PCI for STEMI.