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Prognostic value of erythrocyte sedimentation rate in ST segment elevation myocardial infarction: interaction with
J R Timmer1, J P Ottervanger, J C A Hoorntje
1Department of Cardiology, Isala Klinieken, locatie Weezenlanden, Zwolle, The Netherlands.
Objectives:
Many inflammatory markers are associated with an adverse prognosis after ST segment elevation myocardial infarction (STEMI). Hyperglycaemia may exacerbate this inflammatory response. We investigated whether the erythrocyte sedimentation rate (ESR) was associated with an adverse prognosis and whether this was mediated by glucose levels.
Research Design And Methods:
It concerns a post hoc analysis of a prospective randomised trial. In 346 patients with STEMI treated with reperfusion therapy, we investigated long-term outcome. Patients with ESR in the upper quartile (>14 mm h(-1)) were compared to patients with a normal ESR. Hyperglycaemia was defined as admission glucose >or=7.8 mmol L(-1). Median follow up was 7.4 years (range: 5.7-8.3).
Main Outcome Measures:
All cause mortality, cardiovascular mortality, sudden death, death as a result of heart failure.
Results:
Both elevated ESR and hyperglycaemia were associated with a worse prognosis and increased mortality. Elevated ESR was particularly associated with an increased risk of sudden death (OR: 3.3, 17% vs. 6%, P < 0.01) whereas hyperglycaemia was especially associated with an increased risk of death because of heart failure (OR: 6.5, 8% vs. 1%, P < 0.01). There was no association between increased ESR and elevated glucose levels. Multivariate analysis did reveal that both elevated ESR and admission glucose were independent predictors of long-term mortality.
Conclusions:
Elevated ESR and admission glucose are independent predictors of mortality in STEMI patients treated with reperfusion therapy. There is no association or interaction between glucose levels and the inflammatory response as reflected by ESR.