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Published on: January 28, 2020
Prognostic implication of hyperglycemia in myocardial infarction and primary angioplasty
Matthew I Worthley1, Fiona M Shrive, Todd J Anderson
1Foothills Interventional Cardiology Service, Department of Cardiovascular Sciences and the Libin Cardiovascular Institute, Calgary, Alberta.
Insights
Elevated blood glucose levels upon admission for ST-segment elevation myocardial infarction (STEMI) treated with primary angioplasty are linked to higher in-hospital mortality. This finding highlights the importance of glucose management in STEMI patients.
Area of Science:
- Cardiology
- Endocrinology
- Internal Medicine
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical cardiovascular event.
- Primary angioplasty is a key reperfusion therapy for STEMI.
- The role of admission glucose levels in STEMI outcomes requires further elucidation.
Purpose of the Study:
- To investigate the association between admission blood glucose levels and in-hospital mortality.
- To assess this relationship in patients with STEMI undergoing primary angioplasty.
Main Methods:
- A cohort of 980 STEMI patients treated with primary angioplasty was analyzed.
- Patients were stratified into four quartiles based on admission blood glucose.
- In-hospital mortality was the primary endpoint.
Main Results:
- In-hospital mortality rates increased significantly with higher admission glucose levels (P<.001).
- The highest quartile of glucose (>181 mg/dL) showed a 10% mortality rate, compared to 0.4% in the lowest quartile (<119 mg/dL).
- Diabetes status influenced mortality, but elevated glucose remained a significant predictor.
Conclusions:
- Elevated admission blood glucose is a significant independent predictor of in-hospital mortality in STEMI patients treated with primary angioplasty.
- These findings underscore the prognostic importance of glycemic control in acute myocardial infarction.
- Further research into glucose management strategies for STEMI patients is warranted.
Purpose:
The study assessed the relationship of admission blood glucose level to in-hospital mortality in patients presenting with an ST-segment elevation myocardial infarction and treated with primary angioplasty.
Methods:
A total of 980 patients presenting with an ST-segment elevation myocardial infarction and treated exclusively with primary angioplasty were evaluated. Patients were divided into quartiles based on their admission blood glucose level: group 1 (< or =6.6 mmol/L [< or =119 mg/dL]), group 2 (6.7-7.8 mmol/L [120-140 mg/dL]), group 3 (7.9-10.0 mmol/L [141-180 mg/dL], and group 4 (> or =10.1 mmol/L [> or =181 mg/dL]. The primary end point was in-hospital mortality.
Results:
The mean age of the patient cohort was 62 years, 260 (27%) of whom were female. The mean admission blood glucose level was 9.1+/-4.4 mmol/L (164+/-79 mg/dL). At admission, 16% of this group were known to have diabetes. The in-hospital mortality rate was 3.8% (n=37), 5.2% in the diabetic group (n=8) and 3.5% (n=29) in the nondiabetic group. In-hospital mortality rates were significantly increased in patients with an elevated admission blood glucose level (P<.001). The in-hospital deaths in each admission blood glucose level quartile were 0.4% (n=1) in group 1, 2% (n=6) in group 2, 2% (n=6) in group 3, and 10% (n=24) in group 4.
Conclusions:
In this cohort of patients who were admitted with an ST-segment elevation myocardial infarction and treated exclusively with primary angioplasty, elevated admission blood glucose level is significantly associated with an increase in in-hospital mortality.
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