Blood glucose level on admission determines in-hospital and long-term mortality in patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock treated with percutaneous coronary intervention.
BACKGROUND
It has been shown that hyperglycaemia is associated with increased in-hospital and long-term mortality in patients with myocardial infarction (MI). There are only a few reports on the relationship between glycaemia in the acute phase of MI complicated by cardiogenic shock (CS) and prognosis.


OBJECTIVE
To assess the relationship between blood glucose level on admission and in-hospital as well as long-term mortality in patients with acute ST-segment elevation MI (STEMI) complicated by CS treated with percutaneous coronary intervention (PCI).


METHODS
Consecutive patients with STEMI complicated by CS treated with PCI were included. For the purpose of this analysis, the patients were divided into two groups: the first group included patients with glycaemia on admission < 7.8 mmol/L, and the other group patients with glycaemia > or = 7.8 mmol/L (hyperglycaemia group). Selected parameters from the in-hospital and long-term follow-up were compared between the two groups. Due to a possible linear relationship between blood glucose and mortality in multivariate analysis, glucose level on admission was treated as a continuous variable. The primary outcomes included in-hospital, 1-year and 5-year mortality.


RESULTS
Out of 3166 consecutive patients with STEMI, 258 had CS and available data on glycaemia. In patients with hyperglycaemia on admission, we observed higher in-hospital (41.5% vs 28%, p = 0.041), 1-year (51.4% vs 34.7%, p = 0.015) and 5-year (65.8% vs 43.3%, p = 0.034) mortality in comparison to the patients with blood glucose < 7.8 mmol/L. The multivariate analysis revealed that blood glucose level on admission (per each glycaemia increment by 1 mmol/L) was an independent prognostic factor of in-hospital (OR 1.08, 95% CI 1.02-1.14, p = 0.0044), 1-year (HR 1.04, 95% CI 1.01-1.06, p = 0.005) and 5-year mortality (HR 1.03, 95% CI 1.01-1.05, p = 0.045). Of note, the diagnosis of diabetes mellitus had no influence on in-hospital and long-term mortality.


CONCLUSIONS
Elevated blood glucose level on admission, regardless of the diagnosis of diabetes mellitus, results in increased in-hospital and long-term mortality in patients with STEMI complicated by CS and treated with PCI.
Pres
Damian
D
Department of Cardiology, Silesian Medical University, Zabrze, Poland. damianpres@wp.pl
Gasior
Mariusz
M
Strojek
Krzysztof
K
Gierlotka
Marek
M
Hawranek
Michał
M
Lekston
Andrzej
A
Wilczek
Krzysztof
K
Tajstra
Mateusz
M
Gumprecht
Janusz
J
Poloński
Lech
L
D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D001786:Blood Glucose / Q000378:metabolism*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000378:metabolism; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D006943:Hyperglycemia / Q000453:epidemiology* / Q000378:metabolism*; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000378:metabolism / Q000401:mortality* / Q000628:therapy*; D011379:Prognosis; D012770:Shock, Cardiogenic / Q000453:epidemiology / Q000628:therapy; D012907:Smoking / Q000453:epidemiology
D001786:Blood Glucose