Elsevier

American Heart Journal

Volume 148, Issue 3, September 2004, Pages 399-404
American Heart Journal

Clinical investigation
Prognostic value of admission glucose in non-diabetic patients with myocardial infarction

https://doi.org/10.1016/j.ahj.2004.04.007Get rights and content

Abstract

Background

Patients with acute myocardial infarction (AMI) who have diabetes have an increased risk of death. In nondiabetic patients, admission glucose levels may be a predictor of survival. However, data regarding admission glucose and long-term outcome in nondiabetic patients treated with reperfusion therapy for AMI are limited.

Methods

We investigated long-term clinical outcome in 356 consecutive nondiabetic patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention or thrombolysis as reperfusion therapy. Mean follow-up time was 8 ± 2 years. The patients were divided on the basis of admission glucose level: group 1, <7.8 mmol/L; group 2, 7.8 to 11.0 mmol/L; and group 3, ≥11.1 mmol/L.

Results

Mortality rate in group 1 (n = 163) was 19.0%; in group 2 (n = 151), 26.5%; and in group 3 (n = 42), 35.7% (P < .05). Higher glucose levels were associated with larger enzymatic infarct sizes (P < .01) and more reduced residual left ventricular function (P < .05). Multivariate analysis showed that Killip class >1 at admission (OR, 2.9; 95% CI, 1.7 to 5.0; P < .001), age ≥60 years (OR, 2.4; 95% CI, 1.5 to 4.0, P = .001), thrombolysis as compared with percutaneous coronary intervention (OR, 1.7; 95% CI, 1.1 to 2.7, P = .02), admission glucose category (OR, 1.4; 95% CI, 1.0 to 1.9, P = .04), and anterior location (OR, 1.6; 95% CI, 1.0 to 2.6, 0.03) were independent predictors of long-term clinical outcome.

Conclusions

Elevated admission glucose levels in nondiabetic patients treated with reperfusion therapy for ST-segment elevation myocardial infarction are independently associated with larger infarct size and higher long-term mortality rates.

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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