Persistent hyperglycemia is an independent predictor of outcome in acute myocardial infarction.
BACKGROUND
Elevated blood glucose values are a prognostic factor in myocardial infarction (MI) patients. The unfavourable relation between hyperglycemia and outcome is known for admission glucose and fasting glucose after admission. These predictors are single measurements and thus not indicative of overall hyperglycemia. Increased persistent hyperglycemia may better predict adverse events in MI patients.


METHODS
In a prospective study of MI patients treated with primary percutaneous coronary intervention (PCI) frequent blood glucose measurements were obtained to investigate the relation between glucose and the occurrence of major adverse cardiac events (MACE) at 30 days follow-up. MACE was defined as death, recurrent infarction, repeat primary coronary intervention, and left ventricular ejection fraction equal to or smaller than 30%.


RESULTS
MACE occurred in 89 (21.3%) out 417 patients. In 17 patients (4.1%) it was a fatal event. A mean of 7.4 glucose determinations were available per patient. Mean +/- SD admission glucose was 10.1 +/- 3.7 mmol/L in patients with a MACE versus 9.1 +/- 2.7 mmol/L in event-free patients (P = 0.0024). Mean glucose during the first two days after admission was 9.0 +/- 2.8 mmol/L in patients with MACE compared to 8.1 +/- 2.0 mmol/L in event free patients (P < 0.0001). The area under the receiver operator characteristic curve was 0.64 for persistent hyperglycemia and 0.59 for admission glucose. Persistent hyperglycemia emerged as a significant independent predictor (P < 0.001).


CONCLUSIONS
Persistent hyperglycemia in MI has a stronger relation with 30-day MACE than elevated glucose at admission.
van der Horst
Iwan C C
IC
Department of Cardiology, University of Groningen Medical Center, University of Groningen, The Netherlands. iwanouk@gmail.com
Nijsten
Maarten W N
MW
Vogelzang
Mathijs
M
Zijlstra
Felix
F
D000368:Aged; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism; D016757:Death, Sudden, Cardiac / Q000209:etiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000628:therapy*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D001786:Blood Glucose