title: Distinct association of admission hyperglycemia with one-year adverse outcome in diabetic and non-diabetic patients with acute ST-elevation myocardial infarction.
abstract: BACKGROUND
  Both admission hyperglycemia (AH) and diabetes mellitus adversely affect the prognosis in acute coronary syndromes. We prospectively assessed the predictive role of AH in patients with acute ST-segment elevation myocardial infarction (STEMI).
  
  
  METHODS
  Three hundred-one consecutive patients hospitalized for STEMI were enrolled. Patients were stratified into four groups based on their history of diabetes and the presence of AH (plasma glucose level >11.0 mmol/l or 200 mg/dl). The pre-specified endpoint was the composite of all-cause mortality, non-fatal MI and stroke after one year follow up.
  
  
  RESULTS
  The incidence of the endpoint was 19.6% (35 all-cause deaths, 21 non-fatal MIs, and 3 strokes). Non-diabetic patients with AH exhibited a significantly higher incidence of the composite endpoint compared to those with neither diabetes nor AH (50% vs. 15.3%, log rank p<0.001) and diabetics with or without AH (50% vs. 17.2% vs. 19.3%, log rank p<0.05 for both). Ejection fraction (HR 0.946, p=0.007), treatment with primary percutaneous coronary intervention (HR=0.488, p=0.041), and AH in the absence of known diabetes (HR 2.207, p=0.043) were the only independent predictors of the endpoint.
  
  
  CONCLUSIONS
  AH in non-diabetic STEMI patients is accompanied by a worse long-term prognosis compared to diabetics (with or without AH) or normoglycemic patients and constitutes a potent predictor of an adverse outcome.
authors.affiliation: First Cardiology Clinic, Hippokration Hospital, University of Athens Medical School, 114 Vas Sofias Ave., Athens, Greece. glaz35@hotmail.com
authors.forename: George
authors.initials: G
authors.lastname: Lazaros
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tsiachris
authors.forename: Charalambos
authors.initials: C
authors.lastname: Vlachopoulos
authors.forename: Christina
authors.initials: C
authors.lastname: Chrysohoou
authors.forename: Anastasios
authors.initials: A
authors.lastname: Milkas
authors.forename: Nikos
authors.initials: N
authors.lastname: Papageorgiou
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tousoulis
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D000368:Aged; D048909:Diabetes Complications / Q000453:epidemiology* / Q000401:mortality; D003920:Diabetes Mellitus / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000453:epidemiology*; D016019:Survival Analysis