title: Admission glucose concentrations independently predict early and late mortality in patients with acute myocardial infarction treated by primary or rescue percutaneous coronary intervention.
abstract: BACKGROUND
  In patients with acute myocardial infarction (MI), increased plasma glucose levels at hospital admission are associated with worse outcome. We aimed to assess the predictive value of admission glucose concentrations on short- and long-term mortality in patients with acute MI undergoing primary or rescue percutaneous coronary intervention (PCI).
  
  
  METHODS
  We analyzed the 30-day and long-term (mean follow-up 3.7 years) outcome of 978 patients prospectively included in a single-center registry of patients with acute MI treated with PCI within 24 hours after onset of symptoms. Patients were classified according to plasma glucose levels at admission: < 7.8 mmol/L (group I, n = 322), 7.8 to 11 mmol/L (group II, n = 348), and > 11.0 mmol/L (group III, n = 308).
  
  
  RESULTS
  Mortality at 30 days was 1.2% in group I, 6.3% in group II, and 16.6% in group III (P < .001). After multivariate adjustment for age, the presence of cardiogenic shock, and TIMI 3 flow after PCI, the association of mortality with glucose classification remained significant (P value for trend = .003). The relative risk of death at 30 days for group III versus group I was 3.9 (95% CI 1.2-13.2). During long-term follow-up, mortality was similar in groups I and II. However, in group III adjusted mortality remained significantly increased compared with group I (relative risk 1.76, CI 1.01-3.08).
  
  
  CONCLUSIONS
  In patients undergoing emergency PCI for acute MI, glucose levels at hospital admission are predictive for short- and long-term survival. Knowledge of admission glucose levels may improve initial bedside risk stratification.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Triemli Hospital, Zurich, Switzerland. edwin.straumann@triemli.stzh.ch
authors.forename: Edwin
authors.initials: E
authors.lastname: Straumann
authors.forename: David J
authors.initials: DJ
authors.lastname: Kurz
authors.forename: Jörg
authors.initials: J
authors.lastname: Muntwyler
authors.forename: Irene
authors.initials: I
authors.lastname: Stettler
authors.forename: Marcel
authors.initials: M
authors.lastname: Furrer
authors.forename: Barbara
authors.initials: B
authors.lastname: Naegeli
authors.forename: Jürgen
authors.initials: J
authors.lastname: Frielingsdorf
authors.forename: Ernst
authors.initials: E
authors.lastname: Schuiki
authors.forename: Raymond
authors.initials: R
authors.lastname: Mury
authors.forename: Osmund
authors.initials: O
authors.lastname: Bertel
authors.forename: Giatgen A
authors.initials: GA
authors.lastname: Spinas
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D001786:Blood Glucose / Q000032:analysis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D001786:Blood Glucose