title: Acute myocardial infarction: high risk ventricular tachyarrhythmias and admission glucose level in patients with and without diabetes mellitus.
abstract: OBJECTIVE
  The aim of this study was to evaluate the impact of glucose levels on admission and High Risk Ventricular Tachyarrhythmia (HRVT) in hospital mortality in patients with Acute Myocardial Infarction (AMI).
  
  
  METHODS
  We studied 1.258 consecutive patients admitted to the Coronary Care Unit with a diagnosis of AMI. Ventricular Fibrillation, sustained and nonsustained Ventricular Tachycardia were considered as HRVT. Association between admission glucose, in-hospital mortality and HRVT was assessed with Cox regression analysis.
  
  
  RESULTS
  The overall incidence of in-hospital HRVT was 20% (254/1258 patients) and in-hospital mortality (115/1.258) was higher in patients with HRVT (20% vs 6%) (p< 0.001). Diabetes Mellitus (DM) was present in 441 patients (35%). Optimal threshold level of glycemia admission to predict ventricular arrhythmia was 180 mg/dl (AUC = 0.716; 0.66- 0.76)(p<0.001). Patients with euglycemia on admission (< 120 mg/dL) had lowest prevalence of HRVT (13%)(OR=0.6;0.46-0.78) in contrast to non DM patients who presented glucose 180 mg/dL that exhibited 2-fold increase of in-hospital HRVT (36%; OR=2.2; 1.6-3)(p<0.001). Multivariate risk adjusted hazard ratio (HR) analysis showed that, blood pressure < 100 mmHg (HR=2.4; 1.6-3.6)(p<0.001), White Blood Count (WBC)>10.000 cell count (HR=1.44;1.02-2)(p=0.04) and admission glycemia 180 mg/dL (HR=1.5; 1.04-2.3)( p=0.03) had a significantly increased risk in in-hospital HRTV only in NDM patients.
  
  
  CONCLUSIONS
  The higher glycemia on admission the higher prevalence of life-threatening arrhythmia and mortality regardless diabetes status in patients presenting with AMI. Elevated initial glucose level and WBC count considered along with other clinical data can assist in life-threatening ventricular arrhythmia in non diabetic patients.
authors.affiliation: Coronary Care Unit, University Clinic Hospital, AV Blasco Ibañez 17, Valencia. 46010, Spain. sanjuan_raf@gva.es
authors.forename: Rafael
authors.initials: R
authors.lastname: Sanjuan
authors.forename: Maria L
authors.initials: ML
authors.lastname: Blasco
authors.forename: Helena
authors.initials: H
authors.lastname: Martinez-Maicas
authors.forename: Nieves
authors.initials: N
authors.lastname: Carbonell
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.forename: Julio
authors.initials: J
authors.lastname: Nuñez
authors.forename: Vicente
authors.initials: V
authors.lastname: Bodí
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D048909:Diabetes Complications / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000097:blood / Q000150:complications / Q000453:epidemiology*
chemical_list: D001786:Blood Glucose