Clinical study: acute coronary syndromes
Is blood glucose an independent predictor of mortality in acute myocardial infarction in the thrombolytic era?

https://doi.org/10.1016/S0735-1097(02)02483-XGet rights and content
Under an Elsevier user license
open archive

Abstract

Objectives

This study was designed to assess the prognostic significance of hyperglycemia in acute myocardial infarction (AMI) in the thrombolytic era using contemporary criteria for hyperglycemia.

Background

Most studies that have examined this issue were performed before the widespread use of disease-modifying therapies and varied in their definition of hyperglycemia, assessment of risk factors, and reported outcomes.

Methods

There were 1,664 consecutively hospitalized patients with AMI between October 1997 and October 1998 from a disease-specific, population-based registry. Patients were stratified according to history of diabetes mellitus and, further, according to whether they had a blood glucose >198 mg/dl (11 mmol/l). The influences of cardiac risk factors, medications, and interventions were analyzed, and multivariate logistic regression was used to determine the influence of blood glucose on mortality.

Results

In patients without a history of diabetes, glucose levels were ≤198 mg/dl in 1,078 patients (Group 1) and >198 mg/dl in 135 (Group 2). Of those with diabetes, glucose levels were ≤198 mg/dl in 169 patients (Group 3) and >198 mg/dl in 282 (Group 4). Compared with Group 1 patients, the odds ratios (95% confidence interval) for in-hospital mortality among those in Groups 2, 3, and 4 were 2.44 (1.42 to 4.20; p = 0.001), 1.87 (1.05 to 3.34; p = 0.035), and 1.91 (1.16 to 3.14; p = 0.011), respectively. These groups also had greater 12-month mortality.

Conclusions

Hyperglycemia in AMI is associated with poor outcome even among patients without known diabetes. This finding underlines the need for aggressive glucose management in this setting and may support a more vigorous screening strategy for early recognition of diabetes.

Abbreviations

AMI
acute myocardial infarction
CAD
coronary artery disease
CHF
congestive heart failure
ICONS
Improving Cardiovascular Outcomes in Nova Scotia

Cited by (0)

Dr. Cox receives salary support from a Canadian Institutes of Health Research/Regional Partnership Program Investigator Award and a Clinical Research Scholarship from the Faculty of Medicine, Dalhousie University. The ICONS study is supported through a non-directed educational grant from Merck Frosst Canada Inc. and through in-kind support from the Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada, and the Nova Scotia Department of Health.