title: Admission Glucose and In-hospital Mortality after Acute Myocardial Infarction in Patients with or without Diabetes: A Cross-sectional Study.
abstract: BACKGROUND
  Hyperglycemia on admission has been found to elevate risk for mortality and adverse clinical events after acute myocardial infarction (AMI), but there are evidences that the relationship of blood glucose and mortality may differ between diabetic and nondiabetic patients. Prior studies in China have provided mixed results and are limited by statistical power. Here, we used data from a large, nationally representative sample of patients hospitalized with AMI in China in 2001, 2006, and 2011 to assess if admission glucose is of prognostic value in China and if this relationship differs depending on the presence or absence of diabetes.
  
  
  METHODS
  Using a nationally representative sample of patients with AMI in China in 2001, 2006, and 2011, we categorized patients according to their glucose levels at admission (Results: Compared to patients with euglycemia (5.8%), patients with moderate hyperglycemia (13.1%, odds ratio [OR] = 2.44, 95% confidence interval [CI, 2.08-2.86]), severe hyperglycemia (21.5%, OR = 4.42, 95% CI [3.78-5.18]), and hypoglycemia (13.8%, OR = 2.59, 95% CI [1.68-4.00]), all had higher crude in-hospital mortality after AMI regardless of the presence of recognized diabetes mellitus. After adjustment for patients' characteristics and clinical status, however, the relationship between admission glucose and in-hospital mortality was different for diabetic and nondiabetic patients (P for interaction = 0.045). Among diabetic patients, hypoglycemia (OR = 3.02, 95% CI [1.20-7.63]), moderate hyperglycemia (OR = 1.75, 95% CI [1.04-2.92]), and severe hyperglycemia (OR = 2.97, 95% CI [1.87-4.71]) remained associated with elevated risk for mortality, but among nondiabetic patients, only patients with moderate hyperglycemia (OR = 2.34, 95% CI [1.93-2.84]) and severe hyperglycemia (OR = 3.92, 95% CI [3.04-5.04]) were at elevated mortality risk and not hypoglycemia (OR = 1.12, 95% CI [0.60-2.08]). This relationship was consistent across different study years (P for interaction = 0.900).
  
  
  CONCLUSIONS
  The relationship between admission glucose and in-hospital mortality differs for diabetic and nondiabetic patients. Hypoglycemia was a bad prognostic marker among diabetic patients alone. The study results could be used to guide risk assessment among AMI patients using admission glucose.
  
  
  BACKGROUND
  www.clinicaltrials.gov, NCT01624883; https://clinicaltrials.gov/ct2/show/NCT01624883.
authors.affiliation: Department of Endocrinology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430014, China.
authors.forename: Shi
authors.initials: S
authors.lastname: Zhao
authors.affiliation: Center for Outcomes Research and Evaluation, Yale School of Public Health, Yale University School of Medicine and Yale-New Haven Hospital, New Haven 06510, Connecticut, USA.
authors.forename: Karthik
authors.initials: K
authors.lastname: Murugiah
authors.affiliation: Department of Endocrinology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430014, China.
authors.forename: Na
authors.initials: N
authors.lastname: Li
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Endocrinology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430014, China.
authors.forename: Zi-Hui
authors.initials: ZH
authors.lastname: Xu
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Endocrinology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430014, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Cheng
authors.affiliation: Department of Endocrinology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430014, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Mao
authors.affiliation: Center for Outcomes Research and Evaluation, Yale School of Public Health, Yale University School of Medicine and Yale-New Haven Hospital, New Haven 06510, Connecticut, USA.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Downing
authors.affiliation: Center for Outcomes Research and Evaluation, Yale School of Public Health, Yale University School of Medicine and Yale-New Haven Hospital, New Haven 06510, Connecticut, USA.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
authors.forename: Li-Xin
authors.initials: LX
authors.lastname: Jiang
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood* / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality*; D018570:Risk Assessment
chemical_list: D001786:Blood Glucose