title: Hyperglycemia: still an important predictor of adverse outcomes following AMI in the reperfusion era.
abstract: Hyperglycemia in patients admitted to hospital with myocardial infarction has been associated with adverse outcomes. However, with the improvements in survival seen in the reperfusion era, the glycometabolic state of patients presenting with acute myocardial infarction (AMI) is often given a low priority. The aim of this study was to determine if hyperglycemia remains a significant predictor of cardiac mortality and morbidity in the reperfusion era. We conducted a retrospective review of 158 patients presenting with AMI to our institution, where reperfusion therapy is routinely administered. The glucose level on admission and other risk factors were correlated against adverse cardiac outcomes. From multi-variate logistic regression analysis, admission glucose level was a consistent predictor of mortality and morbidity for all AMI patients as well as those who were reperfused. The odds ratios (OR) of in-hospital and 6-month mortality for each 1 mmol/l increment of glucose level were 1.14 (P = 0.002) and 1.18 (P < 0.001) respectively. For patients who underwent reperfusion therapy, the OR of in-hospital and 6-month mortality for each 1 mmol/l increment of glucose level were 1.27 (P = 0.001) and 1.36 (P = 0.001), respectively. We conclude that in the reperfusion era, hyperglycemia is still associated with adverse cardiac outcomes, although it is unclear whether treatment of hyperglycemia will lead to improved outcomes.
authors.affiliation: Department of Diabetes and Endocrinology, Westmead Hospital, P.O. Box 533, Wentworthville, NSW 2145, Australia. vincentw@westgate.wh.usyd.edu.au
authors.forename: Vincent W
authors.initials: VW
authors.lastname: Wong
authors.forename: David L
authors.initials: DL
authors.lastname: Ross
authors.forename: Kris
authors.initials: K
authors.lastname: Park
authors.forename: Steven C
authors.initials: SC
authors.lastname: Boyages
authors.forename: N Wah
authors.initials: NW
authors.lastname: Cheung
mesh_terms: D000368:Aged; D005260:Female; D006331:Heart Diseases / Q000209:etiology* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications*; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors