title: Stress hyperglycaemia in patients with first myocardial infarction.
abstract: OBJECTIVE
  To investigate the incidence of stress hyperglycaemia at first acute myocardial infarction (MI) with ST-segment elevation, occurrence of stress hyperglycaemia as a manifestation of previously undiagnosed abnormal glucose tolerance (AGT), and its relation to stress hormone levels.
  
  
  METHODS
  The population of this prospective cohort study consisted of 243 patients. On admission glucose, adrenaline, noradrenaline and cortisol levels were measured. Patients without previously diagnosed diabetes (n = 204) underwent an oral glucose tolerance test on day 3 of hospitalisation and 3 months after discharge.
  
  
  RESULTS
  Abnormal glucose tolerance at day 3 was observed in 92 (45.1%) patients without a previous diagnosis of diabetes mellitus and resolved after 3 months in 46 (50.0%) patients (p < 0.0001). Stress hyperglycaemia, defined as admission glycaemia ≥ 11.1 mmol/l, affected 34 (14.0%) study participants: 28 (54.9%) patients with diabetes vs. 3 (8.8%) subjects with newly detected impaired glucose intolerance (p < 0.00001) and 1 (2.2%) person with AGT at day 3 (p < 0.000001). Multivariable analysis identified elevated glycated haemoglobin (HbA(1c) ; p < 0.0000001), anterior MI (p < 0.05) and high admission cortisol concentration (p < 0.001), but not catecholamines, as independent predictors of stress hyperglycaemia. The receiver operating characteristic curve analysis revealed the optimal cut-off values of 8.2% for HbA(1c) and 47.7 μg/dl for admission cortisol with very good and sufficient diagnostic accuracies respectively.
  
  
  CONCLUSIONS
  Newly detected AGT in patients with a first MI is transient in 50% of cases. Stress hyperglycaemia is a common finding in patients with a first MI with ST-segment elevation and diabetes mellitus, but is rarely observed in individuals with impaired glucose tolerance or transient AGT diagnosed during the acute phase of MI. The risk factors of stress hyperglycaemia occurrence include elevated HbA(1c) , anterior MI and high admission cortisol concentration.
authors.affiliation: Department of Endocrinology and Diabetology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland. agabrr@poczta.onet.pl
authors.forename: A
authors.initials: A
authors.lastname: Bronisz
authors.forename: M
authors.initials: M
authors.lastname: Kozinski
authors.forename: P
authors.initials: P
authors.lastname: Magielski
authors.forename: T
authors.initials: T
authors.lastname: Fabiszak
authors.forename: M
authors.initials: M
authors.lastname: Bronisz
authors.forename: I
authors.initials: I
authors.lastname: Swiatkiewicz
authors.forename: A
authors.initials: A
authors.lastname: Sukiennik
authors.forename: B
authors.initials: B
authors.lastname: Beszczynska
authors.forename: R
authors.initials: R
authors.lastname: Junik
authors.forename: J
authors.initials: J
authors.lastname: Kubica
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000523:psychology; D003925:Diabetic Angiopathies / Q000097:blood / Q000523:psychology; D005260:Female; D018149:Glucose Intolerance / Q000523:psychology*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000523:psychology; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors
chemical_list: D006442:Glycated Hemoglobin