Admission hyperglycemia predicts poorer short- and long-term outcomes after primary percutaneous coronary intervention for ST-elevation myocardial infarction.
OBJECTIVE
Admission hyperglycemia is associated with poor outcome in patients with myocardial infarction. The present study evaluated the relationship between admission glucose level and other clinical variables in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).


METHODS
The 959 consecutive STEMI patients undergoing primary PCI were divided into five groups based on admission glucose levels of <100, 100-139, 140-189, 190-249 and ≥250 mg/dL. Their short- and long-term outcomes were compared.


RESULTS
Higher admission glucose levels were associated with significantly higher in-hospital morbidity and mortality, the overall mortality rate at follow up, and the incidence of reinfarction or heart failure requiring admission or leading to mortality at follow up. The odds ratios (95% confidence interval) for in-hospital morbidity, in-hospital mortality, mortality at follow up and re-infarction or heart failure or mortality at follow up of patients with admission glucose levels ≥190 mg/dL, compared with those with admission glucose levels <190 mg/dL, were 2.12 (1.3-3.4, P = 0.001), 2.74 (1.4-5.5, P = 0.004), 2.52 (1.2-5.1, P = 0.01) and 1.70 (1.03-2.8, P = 0.04), respectively. Previously non-diabetic patients with admission glucose levels ≥250 mg/dL had significantly higher in-hospital morbidity or mortality (44 vs 70%, P = 0.03). Known diabetic patients had higher rates of reinfarction, heart failure or mortality at follow up in the 100-139 mg/dL (8 vs 27%, P = 0.04) and 140-189 mg/dL (11 vs 26%, P = 0.02) groups.


CONCLUSIONS
Admission hyperglycemia, especially at glucose levels ≥190 mg/dL, is a predictor of poor prognosis in STEMI patients undergoing primary PCI.
Division of Endocrinology and Metabolism Shin Kong Wu Ho-Su Memorial Hospital Taipei Taiwan.
Pei-Chi
PC
Chen
Graduate Institute of Clinical Medicine College of Medicine Taipei Medical University Taipei Taiwan ; Division of Cardiology Shin Kong Wu Ho-Su Memorial Hospital Taipei Taiwan ; Department of General Medicine Shin Kong Wu Ho-Su Memorial Hospital Taipei Taiwan.
Su-Kiat
SK
Chua
Division of Cardiology Shin Kong Wu Ho-Su Memorial Hospital Taipei Taiwan.
Huei-Fong
HF
Hung
Division of Endocrinology and Metabolism Shin Kong Wu Ho-Su Memorial Hospital Taipei Taiwan.
Chung-Yen
CY
Huang
Department of Emergency Medicine Shin Kong Wu Ho-Su Memorial Hospital Taipei Taiwan ; Institute of Biotechnology National Ilan University Ilan Taiwan ; Institute of Injury Prevention and Control College of Public Health Taipei Medical University Taipei Taiwan.
Chiu-Mei
CM
Lin
Division of Endocrinology and Metabolism Shin Kong Wu Ho-Su Memorial Hospital Taipei Taiwan.
Shih-Ming
SM
Lai
Division of Endocrinology and Metabolism Shin Kong Wu Ho-Su Memorial Hospital Taipei Taiwan.
Yen-Ling
YL
Chen
Division of Cardiology Shin Kong Wu Ho-Su Memorial Hospital Taipei Taiwan.
Jun-Jack
JJ
Cheng
Division of Cardiology Shin Kong Wu Ho-Su Memorial Hospital Taipei Taiwan.
Chiung-Zuan
CZ
Chiu
Division of Cardiology Shin Kong Wu Ho-Su Memorial Hospital Taipei Taiwan.
Shih-Huang
SH
Lee
Division of Cardiology Shin Kong Wu Ho-Su Memorial Hospital Taipei Taiwan.
Huey-Ming
HM
Lo
Graduate Institute of Clinical Medicine College of Medicine Taipei Medical University Taipei Taiwan ; Division of Cardiology Shin Kong Wu Ho-Su Memorial Hospital Taipei Taiwan.
Kou-Gi
KG
Shyu
Acute coronary syndrome; Admission glucose; Diabetes