title: Postprocedural hyperglycemia in ST elevation myocardial infarction submitted to percutaneous coronary intervention: a prognostic indicator and a marker of metabolic derangement.
abstract: BACKGROUND
  Hyperglycemia in acute coronary syndrome is associated with an increased risk of death in patients without previously known diabetes but the prognostic role of postrevascularization hyperglycemia in these patients is so far incompletely elucidated.
  
  
  METHODS
  In 175 consecutive patients without previously known diabetes and with ST elevation myocardial infarction treated with primary angioplasty, we evaluated the relation between acute and chronic glucose dysmetabolism and early and late mortality and the relation between hyperglycemia and extension of myocardial damage [creatine phosphokinase-MB (CPK-MB), troponin I levels, ejection fraction], inflammation (leukocyte count, erythrocyte sedimentation rate, C-reactive protein) and prognostic biohumoral markers [N-terminal brain natriuretic peptide (NT-proBNP) and lactic acid].
  
  
  RESULTS
  Highest glucose levels were associated with higher Killip class, lower ejection fraction and increased values of CPK, CPK-MB, troponin I, proBNP, lactic acid, leukocytes and insulin. At multivariate logistic regression analysis, the following variables were independent predictors of intraintensive cardiac care unit mortality: postprocedural glycemia [odds ratio (OR) 8.79; 95% confidence interval (CI) 1.41-54.94; P = 0.020] and troponin I (OR 1.003; 95% CI 1.0004-1.006; P = 0.023) when adjusted for insulinemia [OR 0.98; 95% CI 0.92-1.06; P = not significant (NS)], HbA1c (OR 0.51; 95% CI 0.11-2.37; P = NS), ST elevation myocardial infarction location (OR 1.27; 95% CI 0.44-3.66; P = NS) and creatininemia (OR 1.48; 95% CI 0.90-2.45; P = NS).
  
  
  CONCLUSIONS
  In ST elevation myocardial infarction patients without previously known diabetes submitted to percutaneous coronary intervention, glucose serum levels measured after mechanical revascularization were independent predictors of in-hospital mortality.
authors.affiliation: Department of Heart and Vessel Disease, Intensive Cardiac Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. lazzeric@libero.it
authors.forename: Chiara
authors.initials: C
authors.lastname: Lazzeri
authors.forename: Marco
authors.initials: M
authors.lastname: Chiostri
authors.forename: Andrea
authors.initials: A
authors.lastname: Sori
authors.forename: Serafina
authors.initials: S
authors.lastname: Valente
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology* / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology; D018836:Inflammation Mediators / Q000097:blood; D019344:Lactic Acid / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D018836:Inflammation Mediators; D010446:Peptide Fragments; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D019344:Lactic Acid; D002097:C-Reactive Protein; D052279:Creatine Kinase, MB Form