Acute hyperglycemia is associated with adverse outcome after acute myocardial infarction in the coronary intervention era.
OBJECTIVE
This study was undertaken to assess the association between acute hyperglycemia and inhospital outcome after acute myocardial infarction (AMI) in the percutaneous coronary intervention (PCI) era. We also assessed outcome of patients with a history of diabetes mellitus in the PCI era.


METHODS
Between January 2001 and December 2001, 1253 patients were admitted to the hospitals within 48 hours after the onset of AMI. Plasma glucose was measured at hospital admission. Acute hyperglycemia was defined as plasma glucose of > 11 mmol/L (198 mg/dL), regardless of the diabetic status. Primary PCI was performed in 898 (72%) patients.


RESULTS
The inhospital mortality rate was significantly higher in patients with acute hyperglycemia than in patients without (16% vs 6%, P < .001). However, there was no significant difference in mortality between diabetic and nondiabetic patients (8% vs 9%, P = .54). Acute hyperglycemia was associated with a higher inhospital mortality rate both in nondiabetic patients (24% vs 6%, P < .001) and in diabetic patients (10% vs 5%, P = .039). Acute hyperglycemia was associated with a higher incidence of no reflow during PCI (21% vs 12%, P < .001), but diabetes was not (14% vs 15%, P = .71).


CONCLUSIONS
Acute hyperglycemia, but not diabetes, was a predictor for inhospital mortality after AMI in the PCI era. No reflow occurred more frequently during PCI in patients with acute hyperglycemia, suggesting that microvascular dysfunction might have contributed to adverse outcome of these patients.
Ishihara
Masaharu
M
Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan. ishifami@fb3.so-net.ne.jp
Kojima
Sunao
S
Sakamoto
Tomohiro
T
Asada
Yujiro
Y
Tei
Chuwa
C
Kimura
Kazuo
K
Miyazaki
Shunichi
S
Sonoda
Masahiro
M
Tsuchihashi
Kazufumi
K
Yamagishi
Masakazu
M
Ikeda
Yoshihiko
Y
Shirai
Mutsunori
M
Hiraoka
Hisatoyo
H
Inoue
Takeshi
T
Saito
Fumio
F
Ogawa
Hisao
H
D000208:Acute Disease; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D048909:Diabetes Complications / Q000401:mortality; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000401:mortality; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000628:therapy*