Elsevier

American Heart Journal

Volume 150, Issue 4, October 2005, Pages 814-820
American Heart Journal

Clinical Investigation
Interventional Cardiology
Acute hyperglycemia is associated with adverse outcome after acute myocardial infarction in the coronary intervention era

https://doi.org/10.1016/j.ahj.2004.12.020Get rights and content

Purpose

This study was undertaken to assess the association between acute hyperglycemia and inhospital outcome after acute myocardial infarction (AMI) in the percutaneous coronary intervention (PCI) era. We also assessed outcome of patients with a history of diabetes mellitus in the PCI era.

Methods

Between January 2001 and December 2001, 1253 patients were admitted to the hospitals within 48 hours after the onset of AMI. Plasma glucose was measured at hospital admission. Acute hyperglycemia was defined as plasma glucose of >11 mmol/L (198 mg/dL), regardless of the diabetic status. Primary PCI was performed in 898 (72%) patients.

Results

The inhospital mortality rate was significantly higher in patients with acute hyperglycemia than in patients without (16% vs 6%, P < .001). However, there was no significant difference in mortality between diabetic and nondiabetic patients (8% vs 9%, P = .54). Acute hyperglycemia was associated with a higher inhospital mortality rate both in nondiabetic patients (24% vs 6%, P < .001) and in diabetic patients (10% vs 5%, P = .039). Acute hyperglycemia was associated with a higher incidence of no reflow during PCI (21% vs 12%, P < .001), but diabetes was not (14% vs 15%, P = .71).

Conclusion

Acute hyperglycemia, but not diabetes, was a predictor for inhospital mortality after AMI in the PCI era. No reflow occurred more frequently during PCI in patients with acute hyperglycemia, suggesting that microvascular dysfunction might have contributed to adverse outcome of these patients.

Section snippets

Patients

The JACSS is a retrospective observational multicenter study conducted at 35 medical institutions.13 Between January 2001 and December 2001, 1640 consecutive patients who were admitted to the participating institutions within 48 hours after the onset of AMI were enrolled in the JACSS. Plasma glucose was measured at the time of hospital admission in 1253 (76%) patients, who constituted the current study group. Acute myocardial infarction was defined by a combination of 2 of the following 3

Patient characteristics

Acute hyperglycemia was associated with older age, more women, more diabetes mellitus, more Killip class ≥2, less previous angina, and shorter time from the onset of AMI to admission (Table I). Diabetes mellitus was associated with younger age, more hypertension, more Killip class ≥2, more previous infarction, higher plasma glucose on admission, and less stent implantation (Table II).

There was no significant difference in medications before AMI between patients with acute hyperglycemia and

Discussion

Although it has been demonstrated that increased plasma glucose at admission is associated with adverse outcome after AMI in the reperfusion era, most of these study patients were treated with thrombolysis, and there were few data on patients undergoing primary PCI.6, 7, 16, 17 Recently, Wahab et al7 have reported that plasma glucose is an independent predictor of mortality after AMI in the thrombolytic era. However, only 34% of the study patients underwent thrombolytic therapy, and PCI was

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This study was supported by the Research Grant for Cardiovascular Disease (14C-4) from the Ministry of Health, Labor, and Welfare.

See Appendices.

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