Clinical investigationPrognostic value of admission glucose in non-diabetic patients with myocardial infarction
Section snippets
Methods
This study concerns a subanalysis of the so-called “Zwolle trial,” a randomized study comparing primary PCI with thrombolysis, as described before.3 Baseline characteristics, clinical data, angiographic data, and outcomes were recorded prospectively in a dedicated database. Patients were enrolled if they had no contraindications for thrombolytic therapy; had symptoms of acute myocardial infarction lasting longer than 30 minutes, accompanied by an electrocardiogram with ST-segment elevation of
Baseline characteristics
The Zwolle trial patient cohort consisted of 395 patients. Of these patients, 32 (8%) had known DM, and no laboratory data were available from 7 patients. Therefore, the present subanalysis included 356 patients. Of the 356 patients, the mean age was 59 ± 10 years, and there were 293 male patients (82%). Residual ejection fraction of the left ventricle (LVEF) was measured in 337 patients (95%) and enzymatic infarct size in 333 patients (94%). During the total follow-up period, 86 patients died
Discussion
Our study demonstrates that in nondiabetic patients with STEMI, elevated glucose levels on admission are associated with larger infarct sizes and increased long-term mortality rates compared with normal glucose levels on admission. Although the pathophysiologic mechanism is unknown, this adverse relation of elevated glucose levels on admission with increased mortality rates is evident, despite the use or method of reperfusion therapy, and adjusting for other predictors of long-term mortality.
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