title: Meta-analysis of admission hyperglycaemia in acute myocardial infarction patients treated with primary angioplasty: a cause or a marker of mortality?
abstract: OBJECTIVE
  Admission hyperglycaemia (AH) has been associated with worse outcomes in acute myocardial infarction (AMI). In the current review, we evaluated the impact of primary angioplasty (pPCI) on mortality in AMI patients with AH. Our second aim was to evaluate if AH is a marker of baseline risk or an independent predictor of mortality.
  
  
  RESULTS
  A comprehensive search of four major databases was performed. We included original research studies reporting data on mortality in AMI patients with AH (mean plasma glucose >156 mg/dL/8.7 mmol) and euglycaemia who were treated with pPCI. Of 481 citations, 12 studies were included in the analysis. Admission hyperglycaemia was associated with a higher 30-day [risk ratio (RR) 4.30, P < 0.0001] and 1- to 3-year mortality (RR 2.26, P < 0.0001). As well, AH was more prevalent in women and in patients with an increasing number of cardiac risk factors or angiographic predictors of mortality, such as previous AMI (RR 0.89, P = 0.01), multivessel coronary disease (RR 0.72, P = 0.0001), and involvement of left anterior descending artery (RR 0.92, P < 0.0001). Moreover, patients with AH had larger infarcts (higher creatine kinase-MB; P = 0.004) and more frequent ventricular arrhythmias (P = 0.002).
  
  
  CONCLUSIONS
  Despite rapid revascularization and treatment of hyperglycaemia, patients with AH continue to have a higher mortality. Admission hyperglycaemia occurs more commonly in patients who have traditional predictors of worse outcomes-specifically prior infarction, anterior wall infarctions, and multivessel disease. Likely, AH is a predictor of rather than a bona fide therapeutic target in AMI.
authors.affiliation: University of Ottawa Heart Institute, Ottawa, ON, Canada K1Y 1J7 Basil Hetzel Institute, University of Adelaide, Adelaide, SA 5000, Australia kjaulakh@gmail.com.
authors.forename: Kuljit
authors.initials: K
authors.lastname: Singh
authors.affiliation: University of Ottawa Heart Institute, Ottawa, ON, Canada K1Y 1J7.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hibbert
authors.affiliation: Department of Clinical Neurosciences, University of North Dakota School of Medicine & Health Sciences, Fargo, ND, USA.
authors.forename: Balwinder
authors.initials: B
authors.lastname: Singh
authors.affiliation: Basil Hetzel Institute, University of Adelaide, Adelaide, SA 5000, Australia.
authors.forename: Kristin
authors.initials: K
authors.lastname: Carson
authors.affiliation: University of Ottawa Heart Institute, Ottawa, ON, Canada K1Y 1J7.
authors.forename: Manuja
authors.initials: M
authors.lastname: Premaratne
authors.affiliation: University of Ottawa Heart Institute, Ottawa, ON, Canada K1Y 1J7.
authors.forename: Michel
authors.initials: M
authors.lastname: Le May
authors.affiliation: University of Ottawa Heart Institute, Ottawa, ON, Canada K1Y 1J7.
authors.forename: Aun-Yeong
authors.initials: AY
authors.lastname: Chong
authors.affiliation: Department of Cardiology, Lyell McEwin Hospital, University of Adelaide, Adelaide, SA 5000, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Arstall
authors.affiliation: University of Ottawa Heart Institute, Ottawa, ON, Canada K1Y 1J7.
authors.forename: Derek
authors.initials: D
authors.lastname: So
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D014943:Global Health; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000601:surgery; D010343:Patient Admission; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
chemical_list: D015415:Biomarkers; D001786:Blood Glucose
keywords: Acute myocardial infarction; Admission hyperglycaemia; Mortality