Admission Glucose and Risk of Early Death in Non-Diabetic Patients with ST-Segment Elevation Myocardial Infarction: A Meta-Analysis

Abstract

BackgroundImpaired admission glucose (AG) is considered to significantly increase risk on both early and late death of the patients with ST-segment elevation myocardial infarction (STEMI), especially for non-diabetic patients; however, some reports contradict the relationship. We therefore conducted a meta-analysis to clarify this issue.Material/MethodsPubMed, EMBASE, Web of Science, and Cochrane Library databases were systematically searched to identify all related prospective cohort studies. The relative risks (RR) with their 95% confidence interval (CI) were pooled quantitatively.ResultsThe pooled RR of early outcome events indicated patients with glucose concentrations ≥6.1–11.1 mmol/L had a 4.38-fold (95% CI, 3.23–5.94) higher early mortality. The pooled RR of late outcome events indicated that the patients with glucose concentrations ≥7.8–11.1 mmol/L had a 1.65-fold (95% CI, 1.33–2.04) higher late mortality based on in-hospital or 30-day survivors.ConclusionsHigh AG may be a helpful prognostic marker of significantly increased risk on early death in non-diabetic patients with STEMI, and has an explicit but prognostic adverse impact on long-term mortality but not early mortality in these patients.

Glycosylated hemoglobin levels and clinical outcomes in nondiabetic patients with coronary artery disease

“…The association of increased blood glucose with short-term mortality has been well established. [ 1 , 2 ] The high blood glucose level is often observed in CAD patients with an acute event owing to stress response. [ 35 ] It is reported that 25% of AMI patients had newly diagnosed DM.…”

“…Acute glycemic disorder, indicated by a high plasma glucose level, is a powerful predictor of prognosis in patients with acute myocardial infarction (AMI) but without diabetes mellitus (DM). [ 1 , 2 ] Increased glucose level may suggest previously undiagnosed DM [ 3 ] ; however, the glycemic test is rarely used to diagnose diabetes in patients encountering AMI because the glucose level could increase at the acute phase of cardiac events in all patients. [ 4 , 5 ] Glycated hemoglobin (HbA1c), reflecting the average blood glucose level of the past 2 to 3 months, is a well-known biomarker of long-term glycometabolic control [ 6 ] and is also recommended in the diagnosis of DM since 2010.…”

Admission glucose level and short-term mortality in older patients with acute myocardial infarction: results from the KORA Myocardial Infarction Registry

“… 37 For example, a meta-analysis including six cohort studies reported that elevated admission glucose (≥6.1–11.1 mmol/L) was significantly associated with short-term mortality in patients with STEMI without diabetes (RR 4.38; 95% CI 3.23 to 5.94). 38 In another study conducted in patients with NSTEMI undergoing PCI, admission blood glucose was a predictor of 30-day major adverse cardiovascular events (MACE), irrespective of diabetes status. 36 Our results suggested that admission glucose might be a predictor of short-term mortality and in-hospital complications in patients with STEMI aged 65–84 years old, while in patients with NSTEMI it was associated with in-hospital complications only.…”