Is Blood Glucose an Independent Predictor of Mortality in Acute Myocardial Infarction in the Thrombolytic Era?

J Am Coll Cardiol. 2002 Nov 20;40(10):1748-54. doi: 10.1016/s0735-1097(02)02483-x.

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 < or =198 mg/dl in 1,078 patients (Group 1) and >198 mg/dl in 135 (Group 2). Of those with diabetes, glucose levels were < or =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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomarkers / blood
  • Blood Glucose / drug effects
  • Blood Glucose / metabolism*
  • Cohort Studies
  • Electrocardiography
  • Evidence-Based Medicine
  • Female
  • Hospital Mortality
  • Humans
  • Hyperglycemia / blood
  • Hyperglycemia / drug therapy
  • Hyperglycemia / mortality
  • Length of Stay
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / blood*
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / mortality*
  • Nova Scotia / epidemiology
  • Predictive Value of Tests
  • Prospective Studies
  • Thrombolytic Therapy*
  • Treatment Outcome

Substances

  • Biomarkers
  • Blood Glucose