Clustering of admission hyperglycemia, impaired renal function and anemia and its impact on in-hospital outcomes in patients with ST-elevation myocardial infarction.
OBJECTIVE
To examine the incidence and inter-relationships between admission hyperglycemia, anemia and impaired renal function and its impact on clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) treated with primary PCI.


METHODS
The study group comprised 1880 patients with STEMI treated with primary PCI, enrolled in a prospective registry.


RESULTS
The primary endpoint of in-hospital death occurred in 88 (4.7%) patients. Hyperglycemia (glucose >11.1mmol/L) was present in 352(18.7%), anemia (hematocrit <36% women, <39% men) in 396(21.1%), and increased serum creatinine (> or =1.2mg/dL women, > or =1.3mg/dL men) in 423(22.5%) patients. 1026(54.6%) subjects had none of the triad risk factors. Two overlapping conditions were observed in 207(11%) and 3 in 40(2.1%) patients. Compared to the expected distribution, an increased prevalence was observed in patients with zero, two or three risk factors, and decreased prevalence was present in patients with one risk factor (p<0.001). In multivariable model including important baseline risk factors and the whole triad risk factors, hyperglycemia, anemia, and increased serum creatinine were independently associated with the primary outcome (hazard ratio (HR); 95% confidence interval (CI): 2.67; 1.56-4.55, and 2.03; 1.19-3.46, and 1.72;1.01-2.93, respectively). Adjusted HR (95% CI) for the incidence of the primary outcome associated with 1, 2 and 3 examined risk factors as compared to 0 of the risk factors was 2.7(1.4-5.4), 5.4(2.6-8.3) and 8.3(3.0-23.2), respectively.


CONCLUSIONS
Hyperglycemia, anemia, and impaired renal function are independently of each other related to in-hospital death in patients with STEMI treated with primary PCI. The triad risk factors cluster and accumulation of these risk factors is related to stepwise, additive increase of risk of in-hospital mortality.
Kruk
Mariusz
M
Catheterization Laboratory and Coronary Disease Unit, Institute of Cardiology, Warsaw, Poland. mariuszkruk2000@yahoo.com
Przyłuski
Jakub
J
Kalińczuk
Lukasz
L
Pregowski
Jerzy
J
Kaczmarska
Edyta
E
Petryka
Joanna
J
Kłopotowski
Mariusz
M
Kepka
Cezary
C
Chmielak
Zbigniew
Z
Demkow
Marcin
M
Ciszewski
Andrzej
A
Piotrowski
Walerian
W
Karcz
Maciej
M
Bekta
Paweł
P
Witkowski
Adam
A
Ruzyłło
Witold
W
D000740:Anemia / Q000150:complications*; D003404:Creatinine / Q000097:blood; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D007674:Kidney Diseases / Q000150:complications*; D007677:Kidney Function Tests; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality*; D012307:Risk Factors; D016896:Treatment Outcome
D003404:Creatinine