title: Prognostic implications of stress hyperglycemia in acute ST elevation myocardial infarction. Prospective observational study.
abstract: OBJECTIVE
  In patients with acute myocardial infarction, elevation of plasma glucose levels is associated with worse outcomes. The aim of this study was to evaluate the association between stress hyperglycemia and in-hospital mortality in patients with acute myocardial infarction with ST-segment elevation (STEMI).
  
  
  METHODS
  We analyzed 834 consecutive patients admitted for STEMI to the Coronary Care Unit of our center. Association between admission glucose and mortality was assessed with Cox regression analysis. Discriminative accuracy of the multivariate model was assessed by Harrell's C statistic.
  
  
  RESULTS
  Eighty-nine (10.7%) patients died during hospitalization. Optimal threshold glycemia level of 140mg/dl on admission to predict mortality was obtained by ROC curves. Those who presented glucose ≥140mg/dl showed higher rates of malignant ventricular tachyarrhythmias (28% vs. 18%, P=.001), complicative bundle branch block (5% vs. 2%, P=.005), new atrioventricular block (9% vs. 5%, P=.05) and in-hospital mortality (15% vs. 5%, P<.001). Multivariate analysis showed that those with glycemia ≥140mg/dl exhibited a 2-fold increase of in-hospital mortality risk (95% CI: 1.2-3.5, P=.008) irrespective of diabetes mellitus status (P-value for interaction=0.487 and 0.653, respectively).
  
  
  CONCLUSIONS
  Stress hyperglycemia on admission is a predictor of mortality and arrhythmias in patients with STEMI and could be used in the stratification of risk in these patients.
authors.affiliation: Unidad Coronaria, Hospital Clínico Universitario, Valencia, España. sanjuan_raf@gva.es
authors.forename: Rafael
authors.initials: R
authors.lastname: Sanjuán
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.forename: M Luisa
authors.initials: ML
authors.lastname: Blasco
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.forename: Helena
authors.initials: H
authors.lastname: Martínez-Maicas
authors.forename: Nieves
authors.initials: N
authors.lastname: Carbonell
authors.forename: Patricia
authors.initials: P
authors.lastname: Palau
authors.forename: Vicente
authors.initials: V
authors.lastname: Bodí
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D013312:Stress, Physiological