Admission glucose concentrations independently predict early and late mortality in patients with acute myocardial infarction treated by primary or rescue percutaneous coronary intervention

Straumann, Edwin; Kurz, David J.; Muntwyler, Jörg; Stettler, Irene; M, Furrer; Naegeli, Barbara; Frielingsdorf, Jürgen; Schuiki, Ernst; Mury, Raymond; Bertel, Osmund; Spinas, Giatgen A.

doi:10.1016/j.ahj.2005.01.033

Cited by 51 publications

(38 citation statements)

References 28 publications

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“…Abnormal glucose metabolism during the acute phase of AMI or ACS is common, and admission hyperglycaemia is associated with increased short-term mortality in both diabetic [11][12][13][17][18][19] and non-diabetic [11][12][13]17,19 patients. Moreover, short-term mortality is predicted even more ORIGINAL ARTICLE VOLUME 4 ISSUE 4 .…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11][12][13][14][15][16][17]19 Admission hyperglycaemia is an even stronger predictor for mortality in patients without a medical history of diabetes. 9,13,19 However, there is little information about differences in outcome between men and women with hyperglycaemia on admission for ACS/AMI.…”

Section: Introductionmentioning

confidence: 99%

“…High blood glucose levels in patients admitted for ACS/AMI are common and are associated with an increased risk of death in both patients with diabetes [9][10][11][12][13][14][15][16][17][18][19] and patients without diabetes. [9][10][11][12][13][14][15][16][17]19 Admission hyperglycaemia is an even stronger predictor for mortality in patients without a medical history of diabetes.…”

Section: Introductionmentioning

confidence: 99%

“…Measurement of glycaemia at hospital admission may therefore be used as an early screening method to detect high-risk patients. Blood glucose concentrations are available within minutes of presentation, at a time when other elements of risk prediction models such as elevated serum markers of myocardial necrosis 17,31,32 may still be normal. According to diabetes guidelines, all patients with coronary artery disease and unknown diabetes status should be screened for type 2 diabetes by an oral glucose tolerance test (OGTT) that gives both fasting and two-hour post-load glucose values, and by measuring HbA 1C .…”

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confidence: 99%

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Admission glycaemia and outcome in patients with acute coronary syndrome

Müdespacher

Radovanovic

Camenzind

et al. 2007

Diabetes and Vascular Disease Research

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Some studies of patients with acute myocardial infarction have reported that hyperglycaemia at admission may be associated with a worse outcome. This study sought to evaluate the association of blood glucose at admission with the outcome of unselected patients with acute coronary syndrome (ACS). Using the Acute Myocardial Infarction and unstable angina in Switzerland (AMIS Plus) registry, ACS patients were stratified according to their blood glucose on admission: group 1: 2.80-6.99 mmol/L, group 2: 7.00-11.09 mmol/L and group 3: > 11.10 mmol/L. Odds ratios for in-hospital mortality were calculated using logistic regression models. Of 2,786 patients, 73% were male and 21% were known to have diabetes. In-hospital mortality increased from 3% in group 1 to 7% in group 2 and to 15% in group 3. Higher glucose levels were associated with larger enzymatic infarct sizes (p<0.001) and had a weak negative correlation with angiographic or echographic left ventricular ejection fraction. High admission glycaemia in ACS patients remains a significant independent predictor of in-hospital mortality (adjusted OR 1.08; 95% confidence intervals [CI] 1.05-1.14, p<0.001) per mmol/L. The OR for in-hospital mortality was 1.04 (95% CI 0.99-1.1; p=0.140) per mmol/L for patients with diabetes but 1.21 (95% CI 112-1.30; p<0.001) per mmol/L for non-diabetic patients. In conclusion, elevated glucose level in ACS patients on admission is a significant independent predictor of in-hospital mortality and is even more important for patients who do not have known diabetes. Using the Acute Myocardial Infarction and unstable angina in Switzerland (AMIS Plus) registry, ACS patients were stratified according to their blood glucose on admission: group 1: 2.80-6.99 mmol/L, group 2: 7.00-11.09 mmol/L and group 3: > 11.10 mmol/L. Odds ratios for in-hospital mortality were calculated using logistic regression models.Of 2,786 patients, 73% were male and 21% were known to have diabetes. In-hospital mortality increased from 3% in group 1 to 7% in group 2 and to 15% in group 3. Higher glucose levels were associated with larger enzymatic infarct sizes (p<0.001) and had a weak negative correlation with angiographic or echographic left ventricular ejection fraction. High admission glycaemia in ACS patients remains a significant independent predictor of in-hospital mortality (adjusted OR 1.08; 95% confidence intervals [CI] 1.05-1.14, p<0.001) per mmol/L. The OR for in-hospital mortality was 1.04 (95% CI 0.99-1.1; p=0.140) per mmol/L for patients with diabetes but 1.21 (95% CI 112-1.30; p<0.001) per mmol/L for non-diabetic patients.In conclusion, elevated glucose level in ACS patients on admission is a significant independent predictor of inhospital mortality and is even more important for patients who do not have known diabetes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Admission glycaemia and outcome in patients with acute coronary syndrome

Müdespacher

Radovanovic

Camenzind

et al. 2007

Diabetes and Vascular Disease Research

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“…R ecent studies have emphasized the prognostic value of high blood glucose levels in patients with acute myocardial infarction (AMI) (1)(2)(3)(4)(5)(6). Previous investigations focused on the relationship between random blood glucose on admission and outcome.…”

Section: Diabetes Care 30:960 -966 2007mentioning

confidence: 99%

Fasting Glucose in Acute Myocardial Infarction

et al. 2007

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OBJECTIVE -Elevation of blood glucose is a common metabolic disorder among patients with acute myocardial infarction (AMI) and is associated with adverse prognosis. However, few data are available concerning the long-term prognostic value of elevated fasting glucose during the acute phase of infarction.RESEARCH DESIGN AND METHODS -We prospectively studied the relationship between fasting glucose and long-term mortality in patients with AMI. Fasting glucose was determined after an Ն8 h fast within 24 h of admission. The median duration of follow-up was 24 months (range 6 -48). All multivariable Cox models were adjusted for the Global Registry of Acute Coronary Events (GRACE) risk score.RESULTS -In nondiabetic patients (n ϭ 1,101), compared with patients with normal fasting glucose (Ͻ100 mg/dl), the adjusted hazard ratio for mortality progressively increased with higher tertiles of elevated fasting glucose (first tertile 1.5 [95% CI 0.8 -2.9], P ϭ 0.19; second tertile 3.2 [1.9 -5.5], P Ͻ 0.0001; third tertile 5.7 [3.5-9.3], P Ͻ 0.0001). The c statistic of the model containing the GRACE risk score increased when fasting glucose data were added (0.8 Ϯ 0.02-0.85 Ϯ 0.02, P ϭ 0.004). Fasting glucose remained an independent predictor of mortality after further adjustment for ejection fraction. Elevated fasting glucose did not predict mortality in patients with diabetes (n ϭ 462).CONCLUSIONS -Fasting glucose is a simple robust tool for predicting long-term mortality in nondiabetic patients with AMI. Fasting glucose provides incremental prognostic information when added to the GRACE risk score and left ventricular ejection fraction. Fasting glucose is not a useful prognostic marker in patients with diabetes. Diabetes Care 30:960 -966, 2007R ecent studies have emphasized the prognostic value of high blood glucose levels in patients with acute myocardial infarction (AMI) (1-6). Previous investigations focused on the relationship between random blood glucose on admission and outcome. We have previously shown that elevated fasting glucose concentrations are superior to admission glucose levels in predicting 30-day mortality in patients with AMI (7). However, few data on the relationship between fasting glucose and long-term outcome are available.Knowledge of mortality predictors in AMI can be used to generate predictive models that can aid clinicians' decisions making, in particular in identifying patients who are at high or low risk of death (8). Such risk assessment methods have been developed for acute coronary syndromes (9 -11). Whether glucose levels can be used to improve the predictive ability of such risk models is not known.Heart failure has been shown to promote insulin resistance and glucose intolerance (12,13), raising the possibility that the association between stress hyperglycemia and adverse outcome is partly mediated through the acute reduction in left ventricular systolic performance. However, the relationship between infarct size or left ventricular dysfunction and the degree of stress hyperglycemia remains...

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Predictive value of the relative lymphocyte count in coronary heart disease

Bian

Shi

et al. 2010

Heart Vessels

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The physiological stress suffered by patients with coronary heart disease (CHD) may result in a shift in leukocyte differential toward a decreased percentage of lymphocytes (L%). The purpose of this study was to determine the prognostic value of a low L% in CHD. One hundred forty patients evaluated in our department between 2007 and 2008 were retrospectively reviewed. Thirty-eight patients had primary percutaneous coronary intervention (PCI), and 102 patients had elective PCI. Various statistical analyses were used to examine the association between a low L% or other clinical characteristics and CHD. Univariate analysis showed that low L% was significantly related to ACS compared with stable CHD or control. White blood cell (WBC) count, C-reactive protein (CRP) and left ventricular systolic dysfunction (LVSD) were also correlated with CHD. Multivariate analysis and logistic regression analysis revealed that L%, CRP, WBC count and LVSD were all independently significant risk factors to have predictive value for CHD and 1 year major adverse cardiac events (MACE). A low L% could be used as an independent predictor for ACS on admission and is associated with MACE during clinical follow-up in CHD patients.

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Admission glucose concentrations independently predict early and late mortality in patients with acute myocardial infarction treated by primary or rescue percutaneous coronary intervention

Cited by 51 publications

References 28 publications

Admission glycaemia and outcome in patients with acute coronary syndrome

Admission glycaemia and outcome in patients with acute coronary syndrome

Fasting Glucose in Acute Myocardial Infarction

Predictive value of the relative lymphocyte count in coronary heart disease

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