title: Comparison of blood glucose values on admission for acute myocardial infarction in patients with versus without diabetes mellitus.
abstract: Previous studies have reported that acute hyperglycemia is associated with high mortality after acute myocardial infarction (AMI). However, optimal plasma glucose level may be different between diabetic and nondiabetic patients. The purpose of this study was to assess the relation between admission glucose and in-hospital mortality after AMI in patients with and without diabetes. This study consisted of 3,750 patients who were admitted to the 35 hospitals participating to the Japanese Acute Coronary Syndrome Study (JACSS) group within 48 hours after the onset of AMI. Plasma glucose was measured at the time of hospital admission. In patients without a history of diabetes, there was a linear relation between admission glucose and in-hospital mortality. Nondiabetic patients with a glucose level <6 mmol/L had the lowest mortality (2.5%). As admission glucose increased by 1 mmol/L, mortality increased by 17% (13% to 21%, p <0.001). In patients with a history of diabetes, however, there was a U-shape relation between glucose and mortality. Diabetic patients with glucose 9 to 10 mmol/L had the lowest mortality (1.9%); not only severe hyperglycemia (glucose > or =11 mmol/L, 9.1%, p <0.001) but also euglycemia (glucose <7 mmol/L, 9.4%, p = 0.009) were associated with higher mortality compared to moderate hyperglycemia (glucose 9 to 11 mmol/L, 3.2%). Diabetic patients with admission glucose 9 to 10 mmol/L had the lowest mortality, whereas lower glucose was better in nondiabetic patients. In conclusion, optimal glucose level on admission may be different between diabetic and nondiabetic patients with AMI.
authors.affiliation: Department of Cardiology, Hiroshima City Hospital, Hiroshima, Kumamoto University School of Medicine, Kumamoto, Japan. ishifami@fb3.so-net.ne.jp
authors.forename: Masaharu
authors.initials: M
authors.lastname: Ishihara
authors.forename: Sunao
authors.initials: S
authors.lastname: Kojima
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
authors.forename: Masami
authors.initials: M
authors.lastname: Kosuge
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Asada
authors.forename: Chuwa
authors.initials: C
authors.lastname: Tei
authors.forename: Shunichi
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sonoda
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Tsuchihashi
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamagishi
authors.forename: Mutsunori
authors.initials: M
authors.lastname: Shirai
authors.forename: Hisatoyo
authors.initials: H
authors.lastname: Hiraoka
authors.forename: Takashi
authors.initials: T
authors.lastname: Honda
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ogata
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003925:Diabetic Angiopathies / Q000097:blood*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000453:epidemiology / Q000401:mortality; D016019:Survival Analysis