Is blood glucose an independent predictor of mortality in acute myocardial infarction in the thrombolytic era?
OBJECTIVE
This study was designed to assess the prognostic significance of hyperglycemia in acute myocardial infarction (AMI) in the thrombolytic era using contemporary criteria for hyperglycemia.


BACKGROUND
Most studies that have examined this issue were performed before the widespread use of disease-modifying therapies and varied in their definition of hyperglycemia, assessment of risk factors, and reported outcomes.


METHODS
There were 1,664 consecutively hospitalized patients with AMI between October 1997 and October 1998 from a disease-specific, population-based registry. Patients were stratified according to history of diabetes mellitus and, further, according to whether they had a blood glucose >198 mg/dl (11 mmol/l). The influences of cardiac risk factors, medications, and interventions were analyzed, and multivariate logistic regression was used to determine the influence of blood glucose on mortality.


RESULTS
In patients without a history of diabetes, glucose levels were < or =198 mg/dl in 1,078 patients (Group 1) and >198 mg/dl in 135 (Group 2). Of those with diabetes, glucose levels were < or =198 mg/dl in 169 patients (Group 3) and >198 mg/dl in 282 (Group 4). Compared with Group 1 patients, the odds ratios (95% confidence interval) for in-hospital mortality among those in Groups 2, 3, and 4 were 2.44 (1.42 to 4.20; p = 0.001), 1.87 (1.05 to 3.34; p = 0.035), and 1.91 (1.16 to 3.14; p = 0.011), respectively. These groups also had greater 12-month mortality.


CONCLUSIONS
Hyperglycemia in AMI is associated with poor outcome even among patients without known diabetes. This finding underlines the need for aggressive glucose management in this setting and may support a more vigorous screening strategy for early recognition of diabetes.
Wahab
Nazneem N
NN
Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada.
Cowden
Elizabeth A
EA
Pearce
Neil J
NJ
Gardner
Martin J
MJ
Merry
Heather
H
Cox
Jafna L
JL
D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D015331:Cohort Studies; D004562:Electrocardiography; D019317:Evidence-Based Medicine; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000188:drug therapy / Q000401:mortality*; D009674:Nova Scotia / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
D015415:Biomarkers; D001786:Blood Glucose