Admission glucose level and in-hospital outcomes in diabetic and non-diabetic patients with acute myocardial infarction.
BACKGROUND
Hyperglycemia on admission is a predictor of unfavorable prognosis in patients with acute myocardial infarction (AMI). Data concerning associations between elevated glucose level on admission and other in-hospital complications are still limited.


METHODS
A total of 607 AMI patients with complete admission glucose data in the Krakow Registry of Acute Coronary Syndromes were identified and were stratified according to glucose admission level.


RESULTS
A total of 71.5% of patients were with admission glucose level <7.8 mmol/l, 17.6% of patients with 7.8-11.0 mmol/l, and 10.9% of patients with ≥11.1 mmol/l. In-hospital mortality for patients treated conservatively was higher in patients with higher admission glucose (8.0 vs. 25.0 vs. 39.1%, respectively, P < 0.0001), and significant mortality difference was confirmed both for diabetic and non-diabetic patients. Admission hyperglycemia was associated with increased risk of ventricular tachycardia/ventricular fibrillation, atrial fibrillation, second to third atriventricular block, pulmonary oeadema, but not ischemic stroke and blood transfusion during index hospital stay.


CONCLUSIONS
Elevated admission glucose levels are associated with increased risk of life-threatening complications, especially arrhythmias in diabetic and non-diabetic AMI patients. This increased risk of complications is one of the possible explanations for the elevated in-hospital mortality in AMI patients presenting with hyperglycemia.
Dziewierz
Artur
A
2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Giszterowicz
Dawid
D
Siudak
Zbigniew
Z
Rakowski
Tomasz
T
Dubiel
Jacek S
JS
Dudek
Dariusz
D
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000097:blood*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000150:complications; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000401:mortality; D011044:Poland / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
D001786:Blood Glucose
Cardiol J. 2008;15(5):451-7
18810721
Circulation. 1999 Nov 16;100(20):2067-73
10562262
Circulation. 2008 Feb 26;117(8):1018-27
18268145
Clin Res Cardiol. 2008 Oct;97(10):753-9
18491170
Kardiol Pol. 2008 May;66(5):489-97, discussion 498-9
18537056
Am J Cardiol. 2002 Aug 15;90(4):358-63
12161222
Eur Heart J. 2007 Apr;28(7):806-13
17403721
Heart. 2001 Nov;86(5):527-32
11602545
Am J Cardiol. 2007 Mar 1;99(5):636-41
17317363
Int J Cardiol. 2007 Apr 4;116(3):315-20
16854479
Am J Cardiol. 2008 Dec 15;102(12):1577-82
19064008
Am Heart J. 2005 Jan;149(1):67-73
15660036
JAMA. 2004 Oct 6;292(13):1555-62
15467057
Heart. 2005 Jul;91(7):889-93
15958356
Eur Heart J. 2005 Feb;26(4):384-416
15681577
Coron Artery Dis. 2007 Jun;18(4):299-303
17496494
Kardiol Pol. 2006 Oct;64(10):1053-60; discussion 1061-2
17089237
J Am Coll Cardiol. 2003 Mar 19;41(6):1013-20
12651051
Lancet. 2000 Mar 4;355(9206):773-8
10711923
Diabetes Care. 2001 Nov;24(11):2016-7
11679491
J Med Assoc Thai. 2007 Oct;90 Suppl 1:58-64
18431887
Diabetes Care. 2008 Aug;31(8):1590-5
18487475
Circulation. 2006 Aug 22;114(8):774-82
16908769
Wien Klin Wochenschr. 2008;120(13-14):409-13
18726666
Circulation. 2008 Mar 25;117(12):1610-9
18299505
Heart. 2008 Jul;94(7):867-73
18332062
Circulation. 2005 Jun 14;111(23):3078-86
15939812
J Am Coll Cardiol. 2005 Apr 5;45(7):999-1002
15808754
Int J Cardiol. 2008 Sep 26;129(2):233-7
17976842
Arch Intern Med. 2004 May 10;164(9):982-8
15136307