[The impact of admission blood glucose level on the prognosis of ST-segment elevation myocardial infarction].
OBJECTIVE
To evaluate the predictive value of admission blood glucose level for the mortality within 30-day and major adverse cardiac events(MACE) rate in patients with ST-segment elevation acute myocardial infarction (STEMI).


METHODS
An observational analysis of 7446 Chinese STEMI patients from a global randomized controlled trials of cases recruited within 12 hours of symptom onset was carried out. According to the levels of admission glucose (hyperglycemia was defined as admission glucose > 10 mmol/L) and known diagnosis of diabetes mellitus (DM), these patients were divided into four groups, I: no DM and normal glucose group (control group); II: DM but normal glucose group; III: no DM and hyperglycemia group; and IV: DM and hyperglycemia group.


RESULTS
Admission hyperglycemia was associated with a significantly higher 30-day mortality rate (group III 17.1% vs group I 8.6%, group IV 18.6% vs group I 8.6%, P < 0.001) and also an increased incidence of MACE (group III 36.3% vs group I 21.6%, group IV 38.8% vs group I 21.6%, P < 0.001). However, DM without admission hyperglycemia did not increase the 30-day mortality (group II 11.6% vs group I 8.6%, P = 0.096). Multivariate logistic regression analysis showed that compared with group I patients, group III and group IV had a risk of death of 1.51 fold ( OR 1.51, 95% CI 1.22-1.87, P <0.001) and 1.83 fold (OR 1.83, 95% CI 1.40-2.39, P <0.001) respectively; hyperglycemia was an independent predictor of 30-day mortality and an increase of 1 mmol/L in glucose level was associated with a 5% increase of mortality risk (OR 1.05, 95% CI 1.04-1.07, P <0.001), but DM without hyperglycemia was not so (OR 1.11, 95% CI 0.87-1.42, P = 0.412).


CONCLUSIONS
The rates of 30-day mortality and cardiovascular events are significantly higher in STEMI patients with acute hyperglycemia than in patients without. Hyperglycemia on admission is an independent risk factor for the short-term outcome of STEMI, but diabetes mellitus without hyperglycemia is not associated with the short-term mortality.
Liu
Yao
Y
Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Emergency, Fuwai Hospital, Beijing, China.
Yang
Yan-Min
YM
Zhu
Jun
J
Tan
Hui-Qiong
HQ
Liang
Yan
Y
Liu
Li-Sheng
LS
Li
Ying
Y
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis
D001786:Blood Glucose