Glucometrics in Patients Hospitalized With Acute Myocardial Infarction

Abstract

Background-Hyperglycemia on admission is associated with an increased mortality rate in patients with acute myocardial infarction. Whether metrics that incorporate multiple glucose assessments during acute myocardial infarction hospitalization are better predictors of mortality than admission glucose alone is not well defined. Methods and Results-We evaluated 16 871 acute myocardial infarction patients hospitalized from January 2000 to December 2005. Using logistic regression models and C indexes, 3 metrics of glucose control (mean glucose, time-averaged glucose, hyperglycemic index), each evaluated over 3 time windows (first 24 hours, 48 hours, entire hospitalization), were compared with admission glucose for their ability to discriminate hospitalization survivors from nonsurvivors. Models were then used to evaluate the relationship between mean glucose and in-hospital mortality. All average glucose metrics performed better than admission glucose. The ability of models to predict mortality improved as the time window increased (C indexes for admission, mean 24 hours, 48 hours, and hospitalization glucose were 0.62, 0.64, 0.66, 0.70; PϽ0.0001). Statistically significant but small differences in C indexes of mean glucose, time-averaged glucose, and hyperglycemic index were seen. Mortality rates increased with each 10-mg/dL rise in mean glucose Ն120 mg/dL (odds ratio, 1.8; Pϭ0.003 for glucose 120 to Ͻ130 mg/dL) and with incremental decline Ͻ70 mg/dL (odds ratio, 6.4; Pϭ0.01 versus glucose 100 to Ͻ110 mg/dL). The slope of these relationships was steeper in patients without diabetes. Conclusions-Measures of persistent hyperglycemia during acute myocardial infarction are better predictors of mortality than admission glucose. Mean hospitalization glucose appears to be the most practical metric of hyperglycemiaassociated risk. A J-shaped relationship exists between average glucose and mortality, with both persistent hyperglycemia and hypoglycemia associated with adverse prognosis.

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

“…In our series, glucose values (when corrected for HOMA index) are independently associated with in-ICCU BMI body mass index, AMI acute myocardial infarction, LVEF left ventricular ejection fraction, PCI percutaneous coronary intervention, Hb A1c glycated hemoglobin, NT-pro-BNP N terminal-pro-brain natriuretic peptide, eGFR estimated glomerular filtration rate * Fisher's exact test Acta Diabetol mortality (thus confirming previous data by others and us) [4][5][6][7][8][9][10][11] and with in-ICCU complications. The complexity of the glycometabolic response to stress during acute myocardial infarction, as well as the scarcity of data on this topic, can be inferred by still existing controversies on how to manage increased glucose values in patients with acute coronary syndromes.…”

“…In patients with ST-elevation myocardial infarction (STEMI), hyperglycemia is common and, though frequently untreated, associated with an increased risk of death [4][5][6][7]. In these patients, increased glucose values hold a prognostic role when measured not only on admission [4] but also throughout hospital stay [8][9][10].…”

Acute hyperglycemia and insulin resistance in acute heart failure syndromes without previously known diabetes

“…Glucose values and acute insulin resistance have been investigated in various acute cardiac conditions [1][2][3][4][5][6][7][8].…”

“…In patients with ST elevation myocardial infarction (STEMI), hyperglycemia is common, and, though frequently untreated, associated with an increased risk of death [1][2][3][4][5]. In these patients, increased glucose values hold a prognostic role when measured not only on admission [1], but also throughout hospital stay [6][7][8].…”

Society of hospital medicine glycemic control task force summary: Practical recommendations for assessing the impact of glycemic control efforts

“…However, a recent observational study of glucometrics in patients hospitalized with acute myocardial infarction found that the simple mean of each patient's glucose values over the entire hospitalization was as predictive of in-hospital mortality as the HGI or the time-averaged glucose (AUC for all glucose values). 4 In this study, metrics derived from glucose readings for the entire hospitalization were more predictive than those based on the first 24 or 48 hours or on the admission glucose.…”