In-hospital daily insulin dose predicts long-term adverse outcome in patients with diabetes with ST-elevation myocardial infarction treated with successful primary percutaneous angioplasty.
BACKGROUND
Early initiation of reperfusion therapy including primary percutaneous coronary revascularization (PPCI) has been recognized as a crucial factor determining clinical outcomes in the acute phase of myocardial infarction. In unstable patients with type 2 diabetes mellitus (T2D) the clear benefit from PPCI was proven. We aim to evaluate the prognostic value of factors describing glycometabolic state on admission in patients with T2D undergoing PPCI in acute ST-elevation myocardial infarction (STEMI).


METHODS
Prospective analysis of clinical and laboratory variables (mean daily short acting exogenous insulin dose (DID), admission blood glucose, glycated hemoglobin (HbA1c), microalbuminuria) was performed in 112 consecutive patients with T2D with STEMI who underwent PPCI. Women comprised 58% of the group.


RESULTS
Insulin dosing was targeted to obtain a mean daily glucose level < 7.8 mmol/l. During 12-month follow-up 33 (29.5%) major adverse cardiac events (major adverse cardiac events (MACE) consisting of death, reinfarction, and repeated target vessel revascularization) were reported. Microalbuminuria was present in 68 (60.5%) patients. The mean HbA1c level was 7.9%. In the multivariate logistic regression model only DID > 44 IU remained an independent risk factor for MACE (p = 0.02, OR = 5.2).


CONCLUSIONS
In patients with diabetes with STEMI treated with PPCI, simple measurement of DID during hospitalization can add valuable prognostic information about the future risk of MACE.
Medical Diagnostics Księży Młyn, Lodz, Poland.
Tomasz
T
Jeżewski
Department of Cardiology, Medical University of Lodz, Bieganski Hospital, Lodz, Poland.
Jan Z
JZ
Peruga
Department of Cardiology, Medical University of Lodz, Bieganski Hospital, Lodz, Poland.
Jarosław D
JD
Kasprzak
Sheffield Teaching Hospitals, Northern General Hospital, Sheffield, UK.
Tomasz
T
Bendinger
Department of Cardiology, Medical University of Lodz, Bieganski Hospital, Lodz, Poland.
Michal
M
Plewka
Department of Cardiology and Cardiosurgery, Medical University of Lodz, Lodz, Poland.
Jarosław
J
Drożdż
Department of Internal Medicine, Diabetology and Clinical Pharmacology, Medical University of Lodz, Lodz, Poland.
Józef
J
Drzewoski
Department of Cardiology, Medical University of Lodz, Bieganski Hospital, Lodz, Poland.
Maria
M
Krzeminska-Pakula
ST-elevation myocardial infarction; daily insulin dose; diabetes; primary percutaneous coronary intervention