Determinants and importance of stress hyperglycaemia in non-diabetic patients with myocardial infarction.

Oswald, G. A.; Smith, Christopher; Betteridge, D. J.; Yudkin, J

doi:10.1136/bmj.293.6552.917

Cited by 245 publications

(156 citation statements)

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“…However, the relation between glucose concentrations and infarct size is controversial. O'Sullivan et al (15) and Thomassen et al (16) found no correlation between glucose levels and infarct size as reflected in peak levels of cardiac enzymes, whereas Oswald et al (17) and Bellodi et al (18) found a weak relation between plasma glucose concentrations and infarct size. Recently, Ishihara et al (15) found lower LVEF among patients with AMI and admission glucose Ͼ10 mmol/l (14).…”

Section: Fasting Glucose and Left Ventricular Functionmentioning

confidence: 96%

“…Elevation of fasting glucose levels in AMI may incorporate the cumulative effects of activation of multiple neurohormonal pathways such as catecholamines, cortisol, and growth hormone (17,26), which can produce or augment insulin resistance (27)(28)(29). Activation of the renin-angiotensin system (30) and the effect of increased circulating cytokines (31) such as tumor necrosis factor-␣ in the setting of AMI infarction may also contribute to a reduction in peripheral insulin sensitivity (32,33).…”

Section: Mechanism Of Stress Hyperglycemiamentioning

confidence: 99%

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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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Section: Fasting Glucose and Left Ventricular Functionmentioning

confidence: 96%

Section: Mechanism Of Stress Hyperglycemiamentioning

confidence: 99%

Fasting Glucose in Acute Myocardial Infarction

et al. 2007

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“…In the setting of acute myocardial infarction [1], hyperglycemia is not simply a marker of pre-existing diabetes or glucose intolerance but it may represent a stress response to myocardial injury mainly related to acute catecholamine release [2,3].…”

Section: Introductionmentioning

confidence: 99%

The glucose dysmetabolism in the acute phase of non-diabetic ST-elevation myocardial infarction: from insulin resistance to hyperglycemia

et al. 2011

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In the setting of acute myocardial infarction, hyperglycemia and acute insulin resistance may represent a stress response to myocardial injury mainly related to acute catecholamine release. By measuring glucose values and insulin resistance (Homeostatic Model Assessment index-HOMA), we evaluated in 356 non-diabetic patients with STelevation myocardial infarction (STEMI) undergone mechanical revascularization: (a) the acute glycometabolic response by evaluating insulin resistance, glucose levels, and their combination and (b) whether insulin resistance and increased glucose values (and their combination) are able to affect in-Intensive Cardiac Care Unit (ICCU) mortality and complications. In the overall population, 226 (63.5%) patients showed glucose values B140 mg/dl (group B), while 130 patients had glucose values[140 mg/dl (group A) (36.5%). Within group B, insulin resistance (as inferred by positive HOMA index) was present in 125 patients (55.3%), whereas 101 patients (44.7%) exhibited normal values of HOMA index. Within group A, 109 patients (83.8%) were insulin resistant, while 21 patients (16.2%) had normal values of HOMA index. At multivariable analysis, glucose values were independently associated with in-ICCU mortality (OR: 7.387; 95% CI 2.701-20.201; P \ 0.001) and complications (OR: 1.786; 95% CI 1.089-2.928; P = 0.022). In the early phase of STEMI, the acute glycometabolic response to stress is heterogeneous (ranging from no insulin resistance to glucose levels[140 mg/dl and, finally, to the combination of increased glucose values and insulin resistance). Increased glucose values are stronger prognostic factors since they are independently associated with in-ICCU mortality and complications.

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“…yperglycemia at the time of hospital admission has been associated with shorter survival after acute myocardial infarction in patients both with and without diabetes (1)(2)(3)(4)(5). It is not fully understood whether this is due to the acute development of stress hyperglycemia or to the quality of long-term metabolic control before the event (6).…”

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confidence: 99%