title: Which is worst in patients undergoing primary angioplasty for acute myocardial infarction? Hyperglycaemia? Diabetes mellitus? Or both?
abstract: OBJECTIVE
  The objective of this study was to evaluate the effect of admission hyperglycaemia and/or diabetes mellitus (DM) on the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
  
  
  METHODS
  2482 consecutive patients with STEMI (mean age 56.5 +/- 11.9, years, 2064 men) undergoing primary PCI between October 2003 and March 2008 were retrospectively enrolled into the present study. Hyperglycaemia was defined as a venous plasma glucose level > or =200 mg/dl on admission. Patients were classified into four groups: non-diabetic/non-hyperglycaemic (NDNH, n=1806) patients; diabetic/non-hyperglycaemic (DNH, n=271) patients; non-diabetic/hyperglycaemic (NDH, n=64); and diabetic/hyperglycaemic (DH, n=341).
  
  
  RESULTS
  In-hospital mortality was higher in NDH (12.5%) compared to DH (8.5%), DNH (6.3%), and NDNH (0.9%) patients (P < 0.001). The composite end points including death, reinfarction, and target-vessel revascularization (major adverse cardiac events [MACE]) in the hospital were also higher in NDH (18.8%) compared with other patients (DH, 13.8% vs. DNH, 10.3% vs. NDNH, 3.7%, P < 0.001). The median follow-up time was 21 months.The Kaplan-Meier survival plot for long-term cardiovascular death was worst for DH patients (log rank P < 0.001). After adjustment for potentially confounding factors, NDH (OR 3.04, 95% CI 1.06-8.73; P = 0.03), and DH (OR 2.3,95% CI 1.29-4.09; P = 0.005), but not DNH (OR 1.22,95% CI 0.57-2.6; P = 0.6) status, remained independent predictors of long-term cardiovascular mortality.
  
  
  CONCLUSIONS
  STEMI patients with NDH represent the highest risk population for in-hospital mortality, and MACE. The worst outcomes for long-term cardiovascular mortality occur in DH patients.
authors.affiliation: Dept. of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey. drmerg@hotmail.com
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ergelen
authors.forename: Huseyin
authors.initials: H
authors.lastname: Uyarel
authors.forename: Gokhan
authors.initials: G
authors.lastname: Cicek
authors.forename: Turgay
authors.initials: T
authors.lastname: Isik
authors.forename: Damirbek
authors.initials: D
authors.lastname: Osmonov
authors.forename: Zeki Yuksel
authors.initials: ZY
authors.lastname: Gunaydin
authors.forename: Mehmet
authors.initials: M
authors.lastname: Bozbay
authors.forename: Ayca
authors.initials: A
authors.lastname: Turer
authors.forename: Mehmet
authors.initials: M
authors.lastname: Gul
authors.forename: Gul Babacan
authors.initials: GB
authors.lastname: Abanonu
authors.forename: Erkan
authors.initials: E
authors.lastname: Ilhan
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome