title: Clinical impact of admission hyperglycemia on in-hospital mortality in acute myocardial infarction patients.
abstract: BACKGROUND
  Acute hyperglycemia on admission is common in acute myocardial infarction (AMI) patients regardless of diabetic status, and is known as one of prognostic factors. However, the effect of hyperglycemia on non-diabetic patients is still on debate.
  
  
  METHODS
  A total of 12,625 AMI patients (64.0±12.6years, 26.1% female) who were enrolled in Korea Acute Myocardial Infarction Registry-National Institute of Health between November 2011 and December 2015, were classified into 4367 diabetes (65.4±11.6years, 30.4% female) and 8228 non-diabetes (63.3±13years, 23.9% female). Patients were analyzed for in-hospital clinical outcome according to admission hyperglycemic status.
  
  
  RESULTS
  In diabetic patients, independent predictors of in-hospital mortality were old age, high HbA1C, pre-Thrombolysis In Myocardial Infarction (TIMI) flow 0, left ventricle ejection fraction<40%, cardiogenic shock and ventricular tachycardia. In non-diabetic patients, independent predictors of in-hospital mortality were old age, high admission glucose (≥200mg/dL), pre TIMI flow 0, failed percutaneous coronary intervention, low left ventricle ejection fraction<40%, cardiogenic shock, stent thrombosis and decreased Hb≥5g/dL. In hospital mortality was significantly higher in diabetic patients compared to non-diabetic patients (5.0% vs. 3.4%, p<0.001). However, non-diabetic patients with hyperglycemia have significantly higher mortality compared to diabetic patients (17.4% vs. 7.2%, p<0.001). Comorbidity including cardiogenic shock (p<0.001), cerebral hemorrhage (p=0.012), decreased Hb≥5g/dL (p=0.013), atrioventricular block (p<0.001) and ventricular tachycardia (p=0.007) was higher in non-diabetic with hyperglycemia than in diabetic patients.
  
  
  CONCLUSIONS
  These findings underscore clinical significance of admission hyperglycemia on in-hospital mortality in non-diabetic AMI patients.
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Kim
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea. Electronic address: myungho@chollian.net.
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Ju Han
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Gachon University Gil Medical Center, Incheon, Republic of Korea.
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Ahn
authors.affiliation: The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Republic of Korea.
authors.forename: Ki Bae
authors.initials: KB
authors.lastname: Seung
authors.affiliation: Korea University Guro Hospital, Seoul, Republic of Korea.
authors.forename: Dong Joo
authors.initials: DJ
authors.lastname: Oh
authors.affiliation: Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Sungkyunkwan Universtiy Samsung Medical Center, Seoul, Republic of Korea.
authors.forename: Hyeon Cheol
authors.initials: HC
authors.lastname: Gwon
authors.affiliation: Chungnam National University Hospital, Daejeon, Republic of Korea.
authors.forename: In Whan
authors.initials: IW
authors.lastname: Seong
authors.affiliation: Chungbuk National University Hospital, Cheongju, Republic of Korea.
authors.forename: Kyung Kuk
authors.initials: KK
authors.lastname: Hwang
authors.affiliation: Kyungpook National University Hospital, Daegu, Republic of Korea.
authors.forename: Shung Chull
authors.initials: SC
authors.lastname: Chae
authors.affiliation: Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.
authors.forename: Kwon-Bae
authors.initials: KB
authors.lastname: Kim
authors.affiliation: Yeungnam University Hospital, Daegu, Republic of Korea.
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Kwang Soo
authors.initials: KS
authors.lastname: Cha
authors.affiliation: Wonkwang University Hospital, Iksan, Republic of Korea.
authors.forename: Seok Kyu
authors.initials: SK
authors.lastname: Oh
authors.affiliation: Chonbuk National University Hospital, Jeonju, Republic of Korea.
authors.forename: Jei Keon
authors.initials: JK
authors.lastname: Chae
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D062645:Percutaneous Coronary Intervention / Q000401:mortality / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology; D013318:Stroke Volume
chemical_list: D001786:Blood Glucose
keywords: Diabetes mellitus; Hyperglycemia; Myocardial infarction