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Impact of hyperglycemia in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary

David Planer1, Bernhard Witzenbichler, Giulio Guagliumi

  • 1Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY 10022, USA.

International Journal of Cardiology
|July 17, 2012
PubMed

Insights

High blood sugar upon admission for ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) predicts higher mortality. This risk applies to both diabetic and non-diabetic patients, impacting both early and late outcomes.

Area of Science:

  • Cardiology
  • Endocrinology
  • Clinical Research

Background:

  • Limited research exists on hyperglycemia's impact in ST-elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (PCI).
  • The prognostic value of admission hyperglycemia in this patient population requires further investigation.

Purpose of the Study:

  • To assess the prognostic significance of admission hyperglycemia in patients with STEMI undergoing primary PCI.
  • To determine if hyperglycemia predicts adverse outcomes in both diabetic and non-diabetic STEMI patients.

Main Methods:

  • Analysis of data from the HORIZONS-AMI trial, including 3405 patients with available admission glucose levels.
  • Stratification of outcomes (30-day and 3-year mortality) by baseline glucose levels and diabetes status.
  • Multivariable analysis and Receiver Operating Characteristic (ROC) curve analysis to identify predictors and optimal cut-off values.

Main Results:

  • Admission hyperglycemia was associated with significantly increased 30-day mortality in all patients, diabetic patients, and non-diabetic patients.
  • Optimal glucose cut-off values for predicting 30-day mortality varied between diabetic (231 mg/dl) and non-diabetic (149 mg/dl) patients.
  • Hyperglycemia independently predicted both 30-day and 3-year mortality across all patient groups.

Conclusions:

  • Admission hyperglycemia is a significant independent predictor of mortality in STEMI patients treated with primary PCI.
  • The prognostic impact of hyperglycemia extends to both early and late mortality, irrespective of known diabetes status.
Abstract

Keywords:
DiabetesHyperglycemiaMortalityPrimary PCIRandomized trialSTEMI

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