Fasting glucose in acute myocardial infarction: incremental value for long-term mortality and relationship with left ventricular systolic function.
OBJECTIVE
Elevation of blood glucose is a common metabolic disorder among patients with acute myocardial infarction (AMI) and is associated with adverse prognosis. However, few data are available concerning the long-term prognostic value of elevated fasting glucose during the acute phase of infarction.


METHODS
We prospectively studied the relationship between fasting glucose and long-term mortality in patients with AMI. Fasting glucose was determined after an >/=8 h fast within 24 h of admission. The median duration of follow-up was 24 months (range 6-48). All multivariable Cox models were adjusted for the Global Registry of Acute Coronary Events (GRACE) risk score.


RESULTS
In nondiabetic patients (n = 1,101), compared with patients with normal fasting glucose (<100 mg/dl), the adjusted hazard ratio for mortality progressively increased with higher tertiles of elevated fasting glucose (first tertile 1.5 [95% CI 0.8-2.9], P = 0.19; second tertile 3.2 [1.9-5.5], P < 0.0001; third tertile 5.7 [3.5-9.3], P < 0.0001). The c statistic of the model containing the GRACE risk score increased when fasting glucose data were added (0.8 +/- 0.02-0.85 +/- 0.02, P = 0.004). Fasting glucose remained an independent predictor of mortality after further adjustment for ejection fraction. Elevated fasting glucose did not predict mortality in patients with diabetes (n = 462).


CONCLUSIONS
Fasting glucose is a simple robust tool for predicting long-term mortality in nondiabetic patients with AMI. Fasting glucose provides incremental prognostic information when added to the GRACE risk score and left ventricular ejection fraction. Fasting glucose is not a useful prognostic marker in patients with diabetes.
Aronson
Doron
D
Department of Cardiology, Rambam Medical Center, Haifa, Israel. daronson@tx.technion.ac.il
Hammerman
Haim
H
Kapeliovich
Michael R
MR
Suleiman
Abeer
A
Agmon
Yoram
Y
Beyar
Rafael
R
Markiewicz
Walter
W
Suleiman
Mahmoud
M
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D003925:Diabetic Angiopathies / Q000097:blood* / Q000401:mortality; D005215:Fasting; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D016019:Survival Analysis; D013599:Systole; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000097:blood*; D016277:Ventricular Function, Left
D001786:Blood Glucose