title: Early glucose variability in cardiogenic shock following acute myocardial infarction: a pilot study.
abstract: BACKGROUND
  No data are so far available on the association between glycaemic variability and outcomes in patients with cardiogenic shock (CS) following ST elevation myocardial infarction (STEMI).
  
  
  METHODS
  We assessed the relationship between glycaemic variability and mortality, both short term and long term, in 67 consecutive patients with cardiogenic shock following STEMI admitted to our Intensive Cardiac Care Unit. Glycaemic variability was measured in the first 48 h by means of standard deviation (SD) of glucose values and the mean absolute glucose change per hour (MAGC) defined as the sum of all absolute glucose change divided by the time in hours.
  
  
  RESULTS
  Lower glycaemic variability was observed in survivors when compared with nonsurvivors, as indicated by lower values of SD and MAGC, respectively. In Cox regression analysis, MAGC and SD were independent predictors of death (MAGC: adjusted hazard ratio [HR]: 8.60, 95% confidence interval [CI]: 2.21-33.41, p = 0.002; SD: adjusted HR: 6.64, 95% CI: 1.92-22.99, p = 0.003), as well as peak glycaemia (adjusted HR: 1.95, 95% CI: 1.20-3.15, p = 0.007).
  
  
  CONCLUSIONS
  According to our results, in patients with CS following acute myocardial infarction, early glycaemic variability is an independent predictor of mortality. Further studies are needed to confirm our results in larger cohorts and eventually to assess the effect of strategies specifically targeting glucose variability reduction on mortality.
authors: Intensive Cardiac Care Unit, Heart and Vessel Department, Viale Morgagni 85, 50134 Florence, Italy lazzeric@libero.it.
authors: Chiara
authors: C
authors: Lazzeri
authors: Intensive Cardiac Care Unit, Heart and Vessel Department, Florence, Italy.
authors: Serafina
authors: S
authors: Valente
authors: Intensive Cardiac Care Unit, Heart and Vessel Department, Florence, Italy.
authors: Marco
authors: M
authors: Chiostri
authors: Intensive Cardiac Care Unit, Heart and Vessel Department, Florence, Italy.
authors: Paola
authors: P
authors: Attanà
authors: Intensive Cardiac Care Unit, Heart and Vessel Department, Florence, Italy and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors: Gian Franco
authors: GF
authors: Gensini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D010865:Pilot Projects; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000401:mortality; D013997:Time Factors
chemical_list: D001786:Blood Glucose
keywords: ST elevation myocardial infarction; cardiogenic shock; glucose values; glycaemic variability; mortality