Impact of acute and chronic hyperglycemia on in-hospital outcomes of patients with acute myocardial infarction

Am J Cardiol. 2014 Dec 15;114(12):1789-93. doi: 10.1016/j.amjcard.2014.09.015. Epub 2014 Sep 28.

Abstract

This study was undertaken to assess the impact of acute hyperglycemia (acute-HG) and chronic hyperglycemia (chronic-HG) on short-term outcomes in patients with acute myocardial infarction (AMI). This study consisted of 696 patients with AMI. Acute-HG was defined as admission plasma glucose ≥200 mg/dl and chronic-HG as hemoglobin A1c ≥6.5%. Acute-HG was associated with higher peak serum creatine kinase (4,094 ± 4,594 vs 2,526 ± 2,227 IU/L, p <0.001) and in-hospital mortality (9.8% vs 1.6%, p <0.001). On the contrary, there was no significant difference in peak creatine kinase (2,803 ± 2,661 vs 2,940 ± 3,181 IU/L, p = 0.59) and mortality (3.3 vs 3.7%, p = 0.79) between patients with chronic-HG and those without. Multivariate analysis showed that admission plasma glucose was an independent predictor of in-hospital mortality (odds ratio 1.15, 95% confidence interval 1.05 to 1.27, p <0.001), but hemoglobin A1c was not. When only patients with acute-HG were analyzed, chronic-HG was associated with a significantly smaller infarct size (3,221 ± 3,001 vs 5,904 ± 6,473 IU/L, p <0.001) and lower in-hospital mortality (5.5 vs 18.9%, p = 0.01). In conclusion, these results suggested that acute-HG, but not chronic-HG, was associated with adverse short-term outcomes after AMI. Paradoxically, in patients with acute-HG, chronic-HG might abate the adverse effects of acute-HG.

Publication types

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

MeSH terms

  • Acute Disease
  • Aged
  • Blood Glucose / metabolism*
  • Chronic Disease
  • Creatine Kinase / blood*
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin A / metabolism*
  • Hospital Mortality / trends
  • Humans
  • Hyperglycemia / blood
  • Hyperglycemia / complications*
  • Inpatients*
  • Japan / epidemiology
  • Male
  • Myocardial Infarction / blood
  • Myocardial Infarction / complications*
  • Myocardial Infarction / mortality
  • Oxidative Stress
  • Prognosis
  • Retrospective Studies
  • Risk Factors

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • Creatine Kinase