Diabetes Mellitus and Glucose as Predictors of Mortality in Primary Coronary Percutaneous Intervention

Abstract

BackgroundDiabetes mellitus and admission blood glucose are important risk factors for mortality in ST segment elevation myocardial infarction patients, but their relative and individual role remains on debate.ObjectiveTo analyze the influence of diabetes mellitus and admission blood glucose on the mortality of ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention.MethodsProspective cohort study including every ST segment elevation myocardial infarction patient submitted to primary coronary percutaneous intervention in a tertiary cardiology center from December 2010 to May 2012. We collected clinical, angiographic and laboratory data during hospital stay, and performed a clinical follow-up 30 days after the ST segment elevation myocardial infarction. We adjusted the multivariate analysis of the studied risk factors using the variables from the GRACE score.ResultsAmong the 740 patients included, reported diabetes mellitus prevalence was 18%. On the univariate analysis, both diabetes mellitus and admission blood glucose were predictors of death in 30 days. However, after adjusting for potential confounders in the multivariate analysis, the diabetes mellitus relative risk was no longer significant (relative risk: 2.41, 95% confidence interval: 0.76 - 7.59; p-value: 0.13), whereas admission blood glucose remained and independent predictor of death in 30 days (relative risk: 1.05, 95% confidence interval: 1.02 - 1.09; p-value ≤ 0.01).ConclusionIn ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention, the admission blood glucose was a more accurate and robust independent predictor of death than the previous diagnosis of diabetes. This reinforces the important role of inflammation on the outcomes of this group of patients.

Two-Hour Post-Load Plasma Glucose, a Biomarker to Improve the GRACE Score in Patients without Known Diabetes

“…The 2h-PG is a better predictor than both APG and FPG [27]. FPG, APG, and HbA 1c , after adjusting for GRS, predict post-MI outcomes in some [12, 13, 16, 19, 20] but not other [11, 14, 15, 17, 18, 21] studies. Attempts at using APG [16-18], FPG [12, 28], and HbA 1c [20] to improve the predictive ability of models containing GRS have yielded conflicting results.…”

“…A glycaemic matrix is notably absent in the GRACE score even though post-ACS prognosis is worse in patients with known diabetes mellitus (DM). Addition of fasting plasma glucose (FPG) [11, 12], admission plasma glucose (APG) [13-19], and glycosylated haemoglobin (HbA 1c ) [20, 21] has been variably successful in improving the GRACE model. The GRACE model predicts post-discharge prognosis up 4 years [3].…”

Glucose-lowering therapy and cardiovascular outcomes in patients with type 2 diabetes mellitus and acute coronary syndrome

“…6 Although IGT and newly diagnosed diabetes are associated with increased rates of major adverse CV events (MACE) and outcomes, 44 admission blood glucose seems to be a more accurate predictor of death than previous diabetes diagnosis. 45 Patients with STEMI undergoing PCI with overt or newly diagnosed diabetes have similar inhospital and 3-year mortality, though mortality is lower in patients with pre-diabetes or no dysglycemia. 6 Postprandial hyperglycemia appears to be a predictive factor of eventfree survival (CV death, non-fatal MI, non-fatal stroke, hospitalization for ACS or coronary revascularization planned after randomization) in patients with type 2 diabetes.…”

The impact of diabetes mellitus on long-term mortality in patients with STEMI after primary PCI

“…Faktori rizika koji su u našoj studiji bili češće zastupljeni kod dijabetičara uključuju starije životno doba, nižu ejekcionu frakciju, prethodni cerebrovaskularni insult, hipertenziju i bubrežnu insuficijenciju. U saglasnosti sa našom studijom su rezultati Vilsona (Wilson) i saradnika, koji navode da je kod ispitanika sa dijabetesom starijeg uzrasta češće prisutni povišeni krvni pritisak, bubrežna insuficijencija i cerebrovaskularni insult (13). Naše istraživanje je, u skladu sa navedenim studijama, pokazalo da bolesnici sa DM češće imaju pridružene faktore rizika, kao i višu stopu komorbiditeta čime je, jednim delom, moguće objasniti povišenu stopu mortaliteta tokom trogodišnjeg praćenja kod ove grupe bolesnika.…”