title: Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes.
abstract: BACKGROUND
  The relationship between admission glucose levels and outcomes in older diabetic and nondiabetic patients with acute myocardial infarction is not well defined.
  
  
  RESULTS
  We evaluated a national sample of elderly patients (n=141,680) hospitalized with acute myocardial infarction from 1994 to 1996. Admission glucose was analyzed as a categorical (< or =110, >110 to 140, >140 to 170, >170 to 240, >240 mg/dL) and continuous variable for its association with mortality in patients with and without recognized diabetes. A substantial proportion of hyperglycemic patients (eg, 26% of those with glucose >240 mg/dL) did not have recognized diabetes. Fewer hyperglycemic patients without known diabetes received insulin during hospitalization than diabetics with similar glucose levels (eg, glucose >240 mg/dL, 22% versus 73%; P<0.001). Higher glucose levels were associated with greater risk of 30-day mortality in patients without known diabetes (for glucose range from < or =110 to >240 mg/dL, 10% to 39%) compared with diabetics (range, 16% to 24%; P for interaction <0.001). After multivariable adjustment, higher glucose levels continued to be associated with a graded increase in 30-day mortality in patients without known diabetes (referent, glucose < or =110 mg/dL; range from glucose >110 to 140 mg/dL: hazard ratio [HR], 1.17; 95% CI, 1.11 to 1.24; to glucose >240 mg/dL: HR, 1.87; 95% CI, 1.75 to 2.00). In contrast, among diabetic patients, greater mortality risk was observed only in those with glucose >240 mg/dL (HR, 1.32; 95% CI, 1.17 to 1.50 versus glucose < or =110 mg/dL; P for interaction <0.001). One-year mortality results were similar.
  
  
  CONCLUSIONS
  Elevated glucose is common, rarely treated, and associated with increased mortality risk in elderly acute myocardial infarction patients, particularly those without recognized diabetes.
authors.affiliation: Section of Cardiovascular Medicine, Yale University School of Medicine, 333 Cedar St, PO Box 208088, New Haven, CT 06520-8088, USA.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Kosiborod
authors.forename: Saif S
authors.initials: SS
authors.lastname: Rathore
authors.forename: Silvio E
authors.initials: SE
authors.lastname: Inzucchi
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.forename: Edward P
authors.initials: EP
authors.lastname: Havranek
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis*; D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000150:complications; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000401:mortality*; D010343:Patient Admission; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose