Predictive value of admission hyperglycaemia on mortality in patients with acute myocardial infarction.
OBJECTIVE
In patients with an acute myocardial infarction, admission hyperglycaemia (AH) is a major risk factor for mortality. However, the predictive value of AH, when the risk score and use of guidelines-recommended treatments are considered, is poorly documented.


METHODS
The first fasting plasma glucose levels after admission, risk level, guidelines-recommended treatment use and 1-year mortality were recorded. Patients with first fasting glucose level after admission > 7.7 mmo/l were considered to have AH.


RESULTS
Three hundred and twenty patients with ST segment elevation myocardial infarction (STEMI) and 404 with non-ST segment elevation myocardial infarction (NSTEMI) were included. One hundred and seventy-five (24%) patients had pre-existing diabetes (diabetes group), 154 (21%) had AH (AH+ group) and the remainding 395 (55%) had neither diabetes nor AH (AH- group). The Global Registry of Acute Coronary Events (GRACE) risk score was lower in the AH- group, but the use of guidelines-recommended treatment was comparable in all groups. At 1 year, the mortality rate was higher in the AH+ group compared with the AH- group (18.8 vs. 6.1%, P < 0.01) and similar to that in the diabetes group (18.8 vs. 16.6%, P = NS). The relation between glycaemic status and mortality remained strong [AH+ vs. AH-, OR = 3.0 (1.5, 6.0) and diabetes vs. AH-, OR = 3.6 (1.7, 6.6)] after adjustment for the GRACE risk score [OR = 2.4 (1.8, 3.1) per 10% increase] and for treatment score [OR = 0.7 (0.6, 0.8) per 10% increase].


CONCLUSIONS
In patients without a history of diabetes, the presence of AH indicates an increased risk of 1-year mortality, similar to that of patients with diabetes, even when the risk score and use of guidelines-recommended treatment are controlled for.
Schiele
F
F
Department of Cardiology, University Hospital Jean-Minjoz, Besançon, France. francois.schiele@ufc-chu.univ-fcomte.fr
Descotes-Genon
V
V
Seronde
M F
MF
Blonde
M C
MC
Legalery
P
P
Meneveau
N
N
Ecarnot
F
F
Mercier
M
M
Penfornis
A
A
Thebault
L
L
Boumal
D
D
Bassand
J-P
JP
D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality*; D003925:Diabetic Angiopathies / Q000401:mortality*; D003955:Diagnostic Tests, Routine / Q000592:standards; D005260:Female; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality*; D011237:Predictive Value of Tests
D001786:Blood Glucose