title: Elevated admission glucose is associated with increased long-term mortality in myocardial infarction patients, irrespective of the initially applied reperfusion strategy.
abstract: BACKGROUND
  It is uncertain if elevated admission plasma glucose (APG) remains an independent determinant of longer-term mortality in myocardial infarction (MI) patients with early restoration of coronary reperfusion by primary percutaneous coronary intervention. The objective of the study was to describe the relation between elevated APG and long-term mortality in MI patients undergoing invasive management.
  
  
  METHODS
  We studied 1,185 consecutive MI patients treated in the Medical Center Alkmaar in the separate years 1996 and 1999 (preinvasive era) and 2003 and 2006 (invasive era). In both eras, APG was derived according to a standard protocol. A multivariate Cox regression model was created to study the relation between APG, reperfusion era, and 5-year mortality.
  
  
  RESULTS
  During a median follow-up of 63 months, 261 patients had died. Mortality was lower in the invasive (19%) than in the preinvasive era (28%). Increased APG was associated with increased mortality, irrespective of the initial reperfusion strategy, although the relation was more pronounced in the preinvasive era (P value for heterogeneity of effects < .001). Each millimole-per-liter APG increase corresponded to a 7% increased mortality (adjusted hazard ratio 1.07, 95% CI 1.04-1.10). Patients with an APG >11 mmol/L had nearly 2-fold higher mortality (hazard ratio 1.9, 95% CI 1.3-2.7) than those with lower values.
  
  
  CONCLUSIONS
  Elevated APG remains a determinant of long-term mortality in MI patients, irrespective of the advances that have been made in reperfusion therapy.
authors.affiliation: Department of Cardiology, Medical Center Alkmaar, The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: de Mulder
authors.forename: Jan-Hein
authors.initials: JH
authors.lastname: Cornel
authors.forename: Tjeerd
authors.initials: T
authors.lastname: van der Ploeg
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Victor A
authors.initials: VA
authors.lastname: Umans
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001786:Blood Glucose / Q000032:analysis*; D017023:Coronary Angiography; D003925:Diabetic Angiopathies / Q000097:blood / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality*; D015425:Myocardial Reperfusion; D011379:Prognosis; D018570:Risk Assessment; D016019:Survival Analysis
chemical_list: D001786:Blood Glucose