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Prognostic value of admission plasma glucose and HbA in acute myocardial infarction
1Department of Endocrinology and Diabetology, University Hospital, Poitiers, France.
Insights
High admission plasma glucose, not HbA1c, predicts mortality after acute myocardial infarction. This indicates that acute stress hyperglycemia, rather than chronic diabetes, is key for prognosis in these patients.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Syndrome
Background:
- Stress hyperglycemia post-acute myocardial infarction (AMI) elevates mortality risk in both diabetic and non-diabetic individuals.
- Understanding the prognostic significance of acute glucose levels versus chronic glycemic control is crucial for patient outcomes.
Purpose of the Study:
- To investigate the independent contributions of admission plasma glucose and hemoglobin A1c (HbA1c) to prognosis following AMI.
- To determine whether acute glycemic status or pre-existing glycemic control better predicts mortality post-AMI.
Main Methods:
- Simultaneous measurement of admission plasma glucose and HbA1c in 146 consecutive AMI patients.
- Classification of patients into 'previously diagnosed diabetes', 'no diabetes', and 'possible diabetes' based on history and HbA1c levels.
- Assessment of patient survival at 5 and 28 days post-admission.
Main Results:
- Higher admission plasma glucose levels were significantly associated with 28-day mortality (P = 0.002).
- HbA1c levels did not show a significant association with mortality.
- Multivariate analysis confirmed admission plasma glucose as an independent predictor of survival, even after adjusting for HbA1c and other clinical factors.
- This association persisted even in the non-diabetic patient subgroup.
Conclusions:
- Admission plasma glucose is a significant prognostic factor for mortality after AMI, independent of HbA1c.
- The acute glycemic state, rather than chronic glycemic control, appears to be the primary determinant of prognosis in the early phase after AMI.
Objective:
Stress hyperglycaemia increases the risk of mortality after acute myocardial infarction in diabetic and in non-diabetic patients. We aimed to determine the contribution of admission plasma glucose and HbA(1c) on post-acute myocardial infarction prognosis.
Patients And Methods:
Admission plasma glucose and HbA(1c) were simultaneously measured in all patients consecutively hospitalized for acute myocardial infarction. Patient survival was measured on 5 and 28 days after admission. Patients were defined as having 'previously diagnosed diabetes' (personal history of diabetes defined using ADA 1997 criteria), 'no diabetes', those without previously diagnosed diabetes and HbA(1c) below 6.5%, or 'possible diabetes', i.e. those without previously diagnosed diabetes and HbA(1c) above 6.5%.
Results:
Of the 146 patients included, four had died by day 5 and 14 by day 28. Admission plasma glucose was higher in patients who had died by day 28 (11.7 +/- 5.8 vs. 8.0 +/- 3.3 mmol/l, P = 0.002), whereas HbA(1c) was not (6.4 +/- 1.9 vs. 6.1 +/- 0.8%, NS). Admission plasma glucose was significantly higher in those who had died by day 28 after adjustment on HbA(1c). A multivariate analysis, including sex, age and heart failure prior to acute myocardial infarction, showed that admission plasma glucose concentration was an independent predictor of survival after acute myocardial infarction. Twenty-seven of the patients had previously diagnosed diabetes and 119 had no history of diabetes. Eleven were found to have possible diabetes. Admission plasma glucose was significantly higher in previously diagnosed diabetes (11.1 +/- 5.6) than in the other groups: 7.7 +/- 2.9 in non-diabetes, 8.2 +/- 2.1 in possible diabetes (P < 0.0001). The relationship between HbA(1c)-adjusted admission plasma glucose and mortality after acute myocardial infarction was also found in the non-diabetes group.
Conclusions:
Admission plasma glucose, even after adjustment on HbA(1c), is a prognostic factor associated with mortality after acute myocardial infarction. Acute rather than the chronic pre-existing glycometabolic state accounts for the prognosis after acute myocardial infarction.
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