Impact of hyperglycemia in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: the HORIZONS-AMI trial.
BACKGROUND
Few studies have examined the association between hyperglycemia and adverse outcomes in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). We therefore evaluated the prognostic utility of admission hyperglycemia in the HORIZONS-AMI trial.


RESULTS
Admission glucose levels were available in 3405 of 3602 (94.5%) enrolled patients, of which 566 patients (16.6%) were known to have diabetes. Outcomes were assessed at 30 days and 3 years, stratified by baseline glucose level and diabetes status. Median [IQR] admission glucose level in the entire study cohort was 138.0 [115.4, 171.0] mg/dl. Multivariable adjusted 30-day mortality was significantly increased in all patients with admission glucose in the highest glucose tertile vs. the lower two-thirds (HR [95%CI]=3.53 [1.89, 6.60], p<0.0001); in patients with diabetes (4.40 [2.04, 9.50], p=0.0002); and in patients without diabetes (3.33 [1.16, 9.55], p=0.03). By ROC analysis, the best cut-off values for 30-day mortality were 169 mg/dl for all patients (AUC=0.76), 149 mg/dl for patients without diabetes (AUC=0.77), and 231 mg/dl for patients with diabetes (AUC=0.69). Baseline hyperglycemia was also an independent predictor of 3-year mortality in all patients (HR [95%CI]=1.93 [1.35, 2.76], P=0.0003), patients with diabetes (2.65 [1.28, 5.47], P=0.008), and patients without diabetes (1.58 [1.05, 2.36], P=0.03).


CONCLUSIONS
In patients with STEMI undergoing primary PCI, admission hyperglycemia is an independent predictor of early and late mortality in both patients with and without known diabetes.
Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY 10022, USA.
David
D
Planer
Bernhard
B
Witzenbichler
Giulio
G
Guagliumi
Jan Z
JZ
Peruga
Bruce R
BR
Brodie
Ke
K
Xu
Martin
M
Fahy
Roxana
R
Mehran
Gregg W
GW
Stone
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies
D001786:Blood Glucose