Admission Glucose and Mortality in Elderly Patients Hospitalized With Acute Myocardial Infarction

Abstract

Background-The relationship between admission glucose levels and outcomes in older diabetic and nondiabetic patients with acute myocardial infarction is not well defined. Methods and Results-We evaluated a national sample of elderly patients (nϭ141 680) hospitalized with acute myocardial infarction from 1994 to 1996. Admission glucose was analyzed as a categorical (Յ110, Ͼ110 to 140, Ͼ140 to 170, Ͼ170 to 240, Ͼ240 mg/dL) and continuous variable for its association with mortality in patients with and without recognized diabetes. A substantial proportion of hyperglycemic patients (eg, 26% of those with glucose Ͼ240 mg/dL) did not have recognized diabetes. Fewer hyperglycemic patients without known diabetes received insulin during hospitalization than diabetics with similar glucose levels (eg, glucose Ͼ240 mg/dL, 22% versus 73%; PϽ0.001). Higher glucose levels were associated with greater risk of 30-day mortality in patients without known diabetes (for glucose range from Յ110 to Ͼ240 mg/dL, 10% to 39%) compared with diabetics (range, 16% to 24%; P for interaction Ͻ0.001).After multivariable adjustment, higher glucose levels continued to be associated with a graded increase in 30-day mortality in patients without known diabetes (referent, glucose Յ110 mg/dL; range from glucose Ͼ110 to 140 mg/dL: hazard ratio [HR], 1.17; 95% CI, 1.11 to 1.24; to glucose Ͼ240 mg/dL: HR, 1.87; 95% CI, 1.75 to 2.00). In contrast, among diabetic patients, greater mortality risk was observed only in those with glucose Ͼ240 mg/dL (HR, 1.32; 95% CI, 1.17 to 1.50 versus glucose Յ110 mg/dL; P for interaction Ͻ0.001). One-year mortality results were similar. Conclusions-Elevated glucose is common, rarely treated, and associated with increased mortality risk in elderly acute myocardial infarction patients, particularly those without recognized diabetes. (Circulation. 2005;111:3078-3086.)

The glucose dysmetabolism in the acute phase of non-diabetic ST-elevation myocardial infarction: from insulin resistance to hyperglycemia

“…In our series, glucose values (when corrected for HOMA index) are independently associated with in-ICCU BMI body mass index, AMI acute myocardial infarction, LVEF left ventricular ejection fraction, PCI percutaneous coronary intervention, Hb A1c glycated hemoglobin, NT-pro-BNP N terminal-pro-brain natriuretic peptide, eGFR estimated glomerular filtration rate * Fisher's exact test Acta Diabetol mortality (thus confirming previous data by others and us) [4][5][6][7][8][9][10][11] and with in-ICCU complications. The complexity of the glycometabolic response to stress during acute myocardial infarction, as well as the scarcity of data on this topic, can be inferred by still existing controversies on how to manage increased glucose values in patients with acute coronary syndromes.…”

“…In patients with ST-elevation myocardial infarction (STEMI), hyperglycemia is common and, though frequently untreated, associated with an increased risk of death [4][5][6][7]. In these patients, increased glucose values hold a prognostic role when measured not only on admission [4] but also throughout hospital stay [8][9][10].…”

Preoperative glucose as a screening tool in patients without diabetes

“…[1][2][3] Reduced morbidity and mortality from improved glycemic control in surgical patients also support the association between hyperglycemia and post-operative outcomes. [4][5][6][7][8][9] However, the risks of unrecognized hyperglycemia (in patients not known to have diabetes) prior to surgical operations remain unclear.…”

Acute hyperglycemia and insulin resistance in acute heart failure syndromes without previously known diabetes

“…Glucose values and acute insulin resistance have been investigated in various acute cardiac conditions [1][2][3][4][5][6][7][8].…”