title: Impaired glucose metabolism predicts mortality after a myocardial infarction.
abstract: Diabetes is a risk factor for increased mortality after a myocardial infarction. Whether this applies for patients with hyperglycemia during the acute phase of a acute myocardial infarction is unclear. Therefore we determined the relation between admission plasma glucose level and mortality in a prospectively collected series of 336 consecutive AMI patients. Patients were divided in four groups based on WHO criteria for glucose levels: I: <5.6 mmol/l, II: 5.6--8.3 mmol/l, III: 8.4--11.0 mmol/l, IV: 11.1 mmol/l. The average age was 68+/-11 years with a peak CK of 1378+/-160 U/l, 34% were anterior wall AMIs and 52% were treated with thrombolysis. All patients had a long-term follow-up control at an average of 14.2 months. One year mortality rate was 19.3% and rose to 44% in patients with glucose levels >11.1 mmol/l. The mortality was higher in diabetic patients than in non-diabetic patients (40 vs. 16%; P<0.05). Multivariate analysis revealed an independent effect of glucose level on mortality. In conclusions, our study in an unselected patient population demonstrates that admission plasma glucose level independently predicts 1 year mortality even in absence of diagnosed diabetes mellitus. Further studies evaluating the effect of acute insulin intervention in reducing mortality are warranted.
authors.affiliation: Department of Cardiology, Medisch Centrum Alkmaar, Postbus 501, 1800 AM Alkmaar, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Bolk
authors.forename: T
authors.initials: T
authors.lastname: van der Ploeg
authors.forename: J H
authors.initials: JH
authors.lastname: Cornel
authors.forename: A E
authors.initials: AE
authors.lastname: Arnold
authors.forename: J
authors.initials: J
authors.lastname: Sepers
authors.forename: V A
authors.initials: VA
authors.lastname: Umans
mesh_terms: D000368:Aged; D001786:Blood Glucose; D016022:Case-Control Studies; D048909:Diabetes Complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000209:etiology; D007333:Insulin Resistance; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality*; D011379:Prognosis; D012306:Risk; D012720:Severity of Illness Index; D013312:Stress, Physiological / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose