Prognostic significance of the change in glucose level in the first 24 h after acute myocardial infarction: results from the CARDINAL study.
OBJECTIVE
In acute myocardial infarction (AMI), baseline hyperglycaemia predicts adverse outcomes, but the relation between subsequent change in glucose levels and outcomes is unclear. We evaluated the prognostic significance of baseline glucose and the change in glucose in the first 24 h following AMI.


RESULTS
We analysed 1469 AMI patients with baseline and 24 h glucose data from the CARDINAL trial database. Baseline glucose and the 24 h change in glucose (24 h glucose level subtracted from baseline glucose) were included in multivariable models for 30- and 180-day mortality. By 30 and 180 days, respectively, 45 and 74 patients had died. In the multivariable 30-day mortality model, neither baseline glucose nor the 24 h change in glucose predicted mortality in diabetic patients (n=250). However, in nondiabetic patients (n=1219), higher baseline glucose predicted higher mortality [hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.04-1.20, per 0.6 mmol/L increase], and a greater 24 h change in glucose predicted lower mortality (HR 0.91, 95% CI 0.86-0.96, for every 0.6 mmol/L drop in glucose in the first 24 h) at 30 days. Baseline glucose and the 24 h change in glucose remained significant multivariable mortality predictors at 180 days in nondiabetic patients.


CONCLUSIONS
Both higher baseline glucose and the failure of glucose levels to decrease in the first 24 h after AMI predict higher mortality in nondiabetic patients.
Goyal
Abhinav
A
Duke Clinical Research Institute and Duke University Medical Center, PO Box 17969, Durham, NC 27715, USA. a.goyal@duke.edu
Mahaffey
Kenneth W
KW
Garg
Jyotsna
J
Nicolau
Jose C
JC
Hochman
Judith S
JS
Weaver
W Douglas
WD
Theroux
Pierre
P
Oliveira
Gustavo B F
GB
Todaro
Thomas G
TG
Mojcik
Christopher F
CF
Armstrong
Paul W
PW
Granger
Christopher B
CB
D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003925:Diabetic Angiopathies / Q000378:metabolism / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000378:metabolism / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000378:metabolism / Q000401:mortality*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic
D001786:Blood Glucose