title: Admission hyperglycemia is associated with failed reperfusion following fibrinolytic therapy in patients with STEMI: results of a retrospective study.
abstract: BACKGROUND
  Hyperglycemia on admission is associated with increased mortality rates in patients with ST-elevation myocardial infarction (STEMI) who are treated with either fibrinolytic therapy (FT) or primary percutaneous coronary intervention (PCI). However, data regarding the relationship between hyperglycemia and the success of FT are lacking. The aim of this study was to investigate the value of admission blood glucose for the prediction of failed reperfusion following FT.
  
  
  RESULTS
  This is a retrospective study of 304 STEMI patients who received FT and whose admission glucose levels were recorded. The main outcome measure was ST segment resolution≥50%. The median (interquartile range [IQR]) blood glucose level in the entire study group was 112 (95-153). In 92 (30.2%) patients, FT was unsuccessful and rescue PCI was performed. Admission glucose (126 [99-192] vs. 110 [94-144] mg/dL, p<0.001), time from symptom onset to FT (180 [120-270] vs. 150 [120-180] min, p=0.009), and maximum ST elevation amplitude (3 [2-7] vs. 3 [2-6] mm, p=0.05) were higher in the failed reperfusion group than in the reperfusion group. Admission hyperglycemia was an independent predictive factor for failed reperfusion (hazard ratio 4.79 [1.80-12.76], p=0.002), along with time from symptom onset to fibrinolysis and anterior wall myocardial infarction.
  
  
  CONCLUSIONS
  In patients with STEMI who undergo FT, admission hyperglycemia is an independent predictor of the failure of fibrinolysis.
authors.affiliation: Department of Cardiology, Istanbul University Institute of Cardiology, Haseki, Aksaray, 34350, Istanbul, Turkey, cuneytkocas@hotmail.com.
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Kocas
authors.forename: Okay
authors.initials: O
authors.lastname: Abaci
authors.forename: Gulumser Sevgin
authors.initials: GS
authors.lastname: Halil
authors.forename: Sukru
authors.initials: S
authors.lastname: Arslan
authors.forename: Gokhan
authors.initials: G
authors.lastname: Cetinkal
authors.forename: Cem
authors.initials: C
authors.lastname: Bostan
authors.forename: Ugur
authors.initials: U
authors.lastname: Coskun
authors.forename: Ahmet
authors.initials: A
authors.lastname: Yildiz
authors.forename: Murat
authors.initials: M
authors.lastname: Ersanli
mesh_terms: D000328:Adult; D000788:Angina Pectoris, Variant / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D003131:Combined Modality Therapy; D003326:Coronary Circulation / Q000187:drug effects*; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000209:etiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D015428:Myocardial Reperfusion Injury / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D010343:Patient Admission; D062645:Percutaneous Coronary Intervention; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy; D061665:Time-to-Treatment; D014421:Turkey / Q000453:epidemiology