title: Ultra-acute increase in blood glucose during prehospital phase is associated with worse short-term and long-term survival in ST-elevation myocardial infarction.
abstract: BACKGROUND
  The current study was to investigate the blood glucose changes in ultra-acute phase in patients with ST-elevation myocardial infarction (STEMI) and its associations with patient outcome.
  
  
  METHODS
  This study was a retrospective population-based observational study utilizing prospectively collected registry data complemented with laboratory data. All adult patients with STEMI treated by emergency medical services (EMS) in the city of Helsinki from January 2006 to December 2010 were included in the study. Both prehospital and hospital admission glucose values were available from 152 (32%) of all STEMI patients (n = 469).
  
  
  RESULTS
  Change in blood glucose from prehospital phase to emergency department admission was significantly higher in non-survivors within 30 days compared to survivors (+1.2 ± 5.1 vs. -0.3 ± 2.4 mmol/l [mean ± SD], P = 0.03). Furthermore, the 3-year survival rate was significantly lower in patients with an evident (≥2 mmol/l) rise in blood glucose (P = 0.02). In patients with impaired left ventricle function (best ejection fraction < 40%), blood glucose increased more compared to patients without it (1.2 ± 2.9 vs. 0.4 ± 2.7 mmol/l, P = 0.01). Increase in glucose was correlated with peak myocardial creatinine kinase (r = 0.17, P = 0.04) as a marker of increased size of infarct, but not with glycosylated haemoglobin A1C as a marker of chronic hyperglycaemia (r = -0.12, P = 0.27).
  
  
  CONCLUSIONS
  In patients with STEMI, ultra-acute hyperglycaemia during prehospital phase is associated with increased mortality, impaired cardiac function and increased size of infarct.
authors.affiliation: Department of Anaesthesia and Intensive Care, Helsinki University Central Hospital, P,O, Box 340, Helsinki, HUS, 00029, Finland. hanna.vihonen@hus.fi.
authors.forename: Hanna
authors.initials: H
authors.lastname: Vihonen
authors.forename: Ilkka
authors.initials: I
authors.lastname: Tierala
authors.forename: Markku
authors.initials: M
authors.lastname: Kuisma
authors.forename: Jyrki
authors.initials: J
authors.lastname: Puolakka
authors.forename: Jukka
authors.initials: J
authors.lastname: Westerbacka
authors.forename: Jouni
authors.initials: J
authors.lastname: Nurmi
mesh_terms: D000208:Acute Disease; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D018450:Disease Progression; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000401:mortality; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D001786:Blood Glucose