Admission hyperglycemia predicts poorer short‐ and long‐term outcomes after primary percutaneous coronary intervention for ST‐elevation myocardial infarction

Abstract

Aims/Introduction: Admission hyperglycemia is associated with poor outcome in patients with myocardial infarction. The present study evaluated the relationship between admission glucose level and other clinical variables in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Materials and Methods: The 959 consecutive STEMI patients undergoing primary PCI were divided into five groups based on admission glucose levels of <100, 100-139, 140-189, 190-249 and ≥250 mg/dL. Their short-and long-term outcomes were compared. Results: Higher admission glucose levels were associated with significantly higher inhospital morbidity and mortality, the overall mortality rate at follow up, and the incidence of reinfarction or heart failure requiring admission or leading to mortality at follow up. The odds ratios (95% confidence interval) for in-hospital morbidity, in-hospital mortality, mortality at follow up and re-infarction or heart failure or mortality at follow up of patients with admission glucose levels ≥190 mg/dL, compared with those with admission glucose levels <190 mg/dL, were 2.12 (1.3-3.4, P = 0.001), 2.74 (1.4-5.5, P = 0.004), 2.52 (1.2-5.1, P = 0.01) and 1.70 (1.03-2.8, P = 0.04), respectively. Previously non-diabetic patients with admission glucose levels ≥250 mg/dL had significantly higher in-hospital morbidity or mortality (44 vs 70%, P = 0.03). Known diabetic patients had higher rates of reinfarction, heart failure or mortality at follow up in the 100-139 mg/dL (8 vs 27%, P = 0.04) and 140-189 mg/dL (11 vs 26%, P = 0.02) groups. Conclusions: Admission hyperglycemia, especially at glucose levels ≥190 mg/dL, is a predictor of poor prognosis in STEMI patients undergoing primary PCI.

Admission hyperglycemia and adverse outcomes in diabetic and non-diabetic patients with non-ST-elevation myocardial infarction undergoing percutaneous coronary intervention

“…Yet, the clinical and prognostic significance of high APG levels have differed between STEMI and NSTEMI patients [8]. Since several similar studies have been conducted on STEMI patients [2, 4, 5], our study focused on NSTEMI patients undergoing PCI, to explore the effects of APG on the rate of after hospital discharge, and its prognostic value in the absence or presence of DM.…”

“…However, most studies have included patients with only ST-elevation myocardial infarction (STEMI) [2, 4, 5] or included both STEMI and non-ST-elevation myocardial infarction (NSTEMI) patients [1, 3, 6–8]. STEMI and NSTEMI are the major types of AMI, and each is associated with different pathophysiological changes, complications, and prognoses [8].…”

Acute Hyperglycemia an Independent Risk Factor for Contrast-Induced Nephropathy in Patients Undergoing Primary Percutaneous Coronary Intervention for STEMI

“…Several studies have demonstrated that acute hyperglycemia is a powerful predictor of mortality, larger infarct size and increased risk of cardiovascular complications in myocardial infarction patients regardless of the diabetic state [30][31][32][33][34][35]. For every 18-mg/ dL increase in glucose level, there is a 4% increase in mortality in nondiabetic patients presenting with myocardial infarction [36].…”

Hyperglycemia in acute coronary syndromes: from mechanisms to prognostic implications

“…In particular, hyperglycemia predicts mortality in patients with ACS, including ST-segment elevation myocardial infarction (STEMI), thrombolysis, and percutaneous coronary revascularization [Capes et al 2000;Zeller et al 2005;Pandey et al 2009;Timmer et al 2011;Eitel et al 2012;Planer et al 2013;Chen et al 2014;Ekmekci et al 2014;Lazzeri et al 2014].…”

“…In the specific setting of patients with STEMI, elevated plasma glucose levels on admission confirmed to be independent prognosticators of both in-hospital and long-term outcome regardless of diabetic status [Malmberg et al 1999;Chen et al 2014]. …”