title: Unrecognized diabetes and myocardial necrosis: predictors of hyperglycemia in myocardial infarction.
abstract: BACKGROUND
  Hyperglycemia in the acute phase of myocardial infarction is an important prognostic factor. However, its pathophysiology is not fully understood.
  
  
  OBJECTIVE
  To analyze simultaneously the correlation between hyperglycemia and biochemical markers related to stress, glucose and lipid metabolism, coagulation, inflammation, and myocardial necrosis. METHODS Eighty patients with acute myocardial infarction were prospectively included. The following parameters were analyzed: blood glucose; stress hormones (cortisol and norepinephrine); glucose metabolism factors [glycated hemoglobin (HbA1c); insulin]; lipoproteins (total cholesterol, LDL, HDL, minimally modified electronegative LDL, and adiponectin); glycerides (triglycerides, VLDL and fatty acids); coagulation factors (factor VII, fibrinogen, plasminogen activator inhibitor-1); inflammation (high-sensitivity C reactive protein); and myocardial necrosis (CK-MB and troponin). Continuous variables were converted into degrees of relevance using fuzzy logic.
  
  
  RESULTS
  Significant correlation was observed between hyperglycemia and glucose metabolism (p < 0.001), lipoproteins (p = 0.03), and necrosis factors (p = 0.03). In the multivariate analysis, only glucose metabolism (OR = 4.3; CI = 2.1-68.9; and p < 0.001) and myocardial necrosis (OR = 22.5; CI = 2-253; and p = 0.012) showed independent and significant correlation. For the analysis of the influence of history of diabetes mellitus, a regression model including only patients without diabetes mellitus was developed, and the results did not change. Finally, in the model adjusted for age, gender, and clinical variables (history of diabetes mellitus, hypertension and dyslipidemia), three variables maintained a significant and independent association with hyperglycemia: glucose metabolism (OR = 24.1; CI = 4.8-122.1; and p < 0.001), myocardial necrosis (OR = 21.9; CI = 1.3-360.9; and p = 0.03), and history of DM (OR = 27; CI = 3.7-195.7; and p = 0.001).
  
  
  CONCLUSIONS
  Glucose metabolism and myocardial necrosis markers were the best predictors of hyperglycemia in patients with acute myocardial infarction.
authors.affiliation: Instituto do Coração (InCor) – Hospital da Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil. rtlad@cardiol.br
authors.forename: Renata Teixeira
authors.initials: RT
authors.lastname: Ladeira
authors.forename: Luciano Moreira
authors.initials: LM
authors.lastname: Baracioli
authors.forename: Tanize Espírito Santo
authors.initials: TE
authors.lastname: Faulin
authors.forename: Dulcinéia Saes Parra
authors.initials: DS
authors.lastname: Abdalla
authors.forename: Talita Matttos
authors.initials: TM
authors.lastname: Seydell
authors.forename: Raul Cavalcante
authors.initials: RC
authors.lastname: Maranhão
authors.forename: Berenice Bilharinho
authors.initials: BB
authors.lastname: Mendonça
authors.forename: Célia Cassaro
authors.initials: CC
authors.lastname: Strunz
authors.forename: Isac de
authors.initials: Id
authors.lastname: Castro
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Nicolau
mesh_terms: D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation / Q000502:physiology; D052279:Creatine Kinase, MB Form / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis*; D004812:Epidemiologic Methods; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis*; D007249:Inflammation / Q000097:blood; D007328:Insulin / Q000097:blood; D008074:Lipoproteins / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000473:pathology; D009336:Necrosis; D013312:Stress, Physiological / Q000502:physiology; D014336:Troponin / Q000097:blood*
chemical_list: D015415:Biomarkers; D052279:Creatine Kinase, MB Form; D006442:Glycated Hemoglobin; D007328:Insulin; D008074:Lipoproteins; D014336:Troponin