Fasting Glucose in Acute Myocardial Infarction

Abstract

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...

Blood glucose and its prognostic implications in patients hospitalised with acute myocardial infarction

“…Many prior studies have observed that the nature of the relationship between initial glucose levels and short-term mortality differs between patients with and without diabetes. 2,15,21,29,30,32 The risk of mortality rises gradually once glucose levels exceed ~110-120 mg/dL (6.1-6.6 mmol/L) in patients without diabetes, whereas in patients with established diabetes the risk does not increase substantially until glucose levels exceed ~200 mg/dL (11.0 mmol/L). 2,29 Thus, different definitions of hyperglycaemia may be appropriate according to whether established diabetes is present.…”

“…25,32,35,36 Unlike the random glucose level on admission, elevated fasting glucose may be a better reflection of abnormalities in underlying glucose metabolism, and thus may be a better predictor both of short-term and long-term outcomes. In one of the earlier studies on this issue, Suleiman et al demonstrated that while both admission and fasting glucose levels predicted 30-day mortality in non-diabetic patients with AMI, fasting glucose was the better discriminator.…”

“…Fasting glucose also added significantly to the discriminating ability of the Global Registry of Acute Coronary Events (GRACE) risk score (a validated tool used to estimate allcause mortality risk in patients with acute coronary syndromes). 32 At least two additional studies have documented the relationship between elevated fasting glucose and increased risk of mortality and heart failure post-AMI. 35,36 As with the previously discussed studies of admission and mean glucose, the relationship between fasting glucose and REVIEW mortality was much stronger in patients without known diabetes than in those with established diabetes.…”

In-Hospital Outcome According to the Initial Management and the "Thrombolysis in Myocardial Infarction Risk Score" of Acute Non-ST Segment Elevation Myocardial Infarction

“…These findings were comparable to the previously reported clinical trials. [12][13][14][15][16] In five large, randomized trials [17][18][19][20][21] [Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQ-WISH), Fragmin and Fast Revascularization during Instability in Coronary Artery Disease (FRISC) II, Treat Angina with Aggrastat and Determine the Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction 18 (TACTICS-TIMI 18), TIMI IIIB and the Third Randomized Intervention Treatment of Angina (RITA-3)], a routine, early invasive strategy (early angiography followed by revascularization, depending on the angiographic findings) was compared with a "conservative" strategy (angiography and subsequent revascularization only if medical therapy failed or substantial residual ischemia was documented). An early invasive strategy was shown to be beneficial by the FRISC II, TACTICS-TIMI 18 and RITA-3 studies, and especially for the subgroups of patients who were at a high risk, such as those patients presenting with an elevated cardiac troponin level.…”

Valor prognóstico da glicemia de jejum em pacientes idosos com síndrome coronariana aguda

“…More recent publications have shown the clinical relevance of fasting glucose level in ACS [19][20][21][22][23][24][25][26][27] . Studies that assessed adequately fasting plasma glucose (FPG) levels in acute myocardial infarction (AMI) patients show that it is a predictor for complications after AMI, and may even be better than admission FPG to predict in-hospital and short-term mortality 19,25,27 . Another study has also shown that FPG was a good predictor of long-term mortality in non-diabetic AMI patients…”