Hyperglycemia on admission predicts larger infarct size in patients undergoing percutaneous coronary intervention for acute ST-segment elevation myocardial infarction

Cruz-González, Ignacio; Chia, Stanley; Raffel, Corey; Sánchez-Ledesma, María; Senatore, Fred; Wackers, Frans J. Th.; Nathan, David M.; Jang, Ik‐Kyung

doi:10.1016/j.diabres.2010.01.001

Cited by 21 publications

(13 citation statements)

References 29 publications

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“…showed that elevated admission glucose levels result in increased in‐hospital and long‐term mortality in STEMI patients complicated by cardiogenic shock, and treated with primary PCI. In two other studies, admission hyperglycemia is associated with larger infarct sizes and more severely impaired epicardial coronary flow when compared with normoglycemic patients.…”

Section: Introductionsupporting

confidence: 93%

Admission hyperglycemia predicts poorer short‐ and long‐term outcomes after primary percutaneous coronary intervention for ST‐elevation myocardial infarction

Chen¹,

Chua

Hung³

et al. 2013

J of Diabetes Invest

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Aims/Introduction: Admission hyperglycemia is associated with poor outcome in patients with myocardial infarction. The present study evaluated the relationship between admission glucose level and other clinical variables in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Materials and Methods: The 959 consecutive STEMI patients undergoing primary PCI were divided into five groups based on admission glucose levels of <100, 100-139, 140-189, 190-249 and ≥250 mg/dL. Their short-and long-term outcomes were compared. Results: Higher admission glucose levels were associated with significantly higher inhospital morbidity and mortality, the overall mortality rate at follow up, and the incidence of reinfarction or heart failure requiring admission or leading to mortality at follow up. The odds ratios (95% confidence interval) for in-hospital morbidity, in-hospital mortality, mortality at follow up and re-infarction or heart failure or mortality at follow up of patients with admission glucose levels ≥190 mg/dL, compared with those with admission glucose levels <190 mg/dL, were 2.12 (1.3-3.4, P = 0.001), 2.74 (1.4-5.5, P = 0.004), 2.52 (1.2-5.1, P = 0.01) and 1.70 (1.03-2.8, P = 0.04), respectively. Previously non-diabetic patients with admission glucose levels ≥250 mg/dL had significantly higher in-hospital morbidity or mortality (44 vs 70%, P = 0.03). Known diabetic patients had higher rates of reinfarction, heart failure or mortality at follow up in the 100-139 mg/dL (8 vs 27%, P = 0.04) and 140-189 mg/dL (11 vs 26%, P = 0.02) groups. Conclusions: Admission hyperglycemia, especially at glucose levels ≥190 mg/dL, is a predictor of poor prognosis in STEMI patients undergoing primary PCI.

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Section: Introductionsupporting

confidence: 93%

Admission hyperglycemia predicts poorer short‐ and long‐term outcomes after primary percutaneous coronary intervention for ST‐elevation myocardial infarction

Chen¹,

Chua

Hung³

et al. 2013

J of Diabetes Invest

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show abstract

“…This is supported by the finding that many young people experiencing MI have undiagnosed diabetes but an absence of other risk factors [17]. Risk factors specifically associated with diabetes include diabetes increased atherosclerotic plaque formation and thrombosis [18] associated with hypergycemia [19]. …”

Section: Discussionmentioning

confidence: 95%

Population based absolute and relative survival to 1 year of people with diabetes following a myocardial infarction: A cohort study using hospital admissions data

et al. 2010

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BackgroundPeople with diabetes who experience an acute myocardial infarction (AMI) have a higher risk of death and recurrence of AMI. This study was commissioned by the Department for Transport to develop survival tables for people with diabetes following an AMI in order to inform vehicle licensing.MethodsA cohort study using data obtained from national hospital admission datasets for England and Wales was carried out selecting all patients attending hospital with an MI for 2003-2006 (inclusion criteria: aged 30+ years, hospital admission for MI (defined using ICD 10 code I21-I22). STATA was used to create survival tables and factors associated with survival were examined using Cox regression.ResultsOf 157,142 people with an MI in England and Wales between 2003-2006, the relative risk of death or recurrence of MI for those with diabetes (n = 30,407) in the first 90 days was 1.3 (95%CI: 1.26-1.33) crude rates and 1.16 (95%CI: 1.1-1.2) when controlling for age, gender, heart failure and surgery for MI) compared with those without diabetes (n = 129,960). At 91-365 days post AMI the risk was 1.7 (95% CI 1.6-1.8) crude and 1.50 (95%CI: 1.4-1.6) adjusted. The relative risk of death or re-infarction was higher at younger ages for those with diabetes and directly after the AMI (Relative risk; RR: 62.1 for those with diabetes and 28.2 for those without diabetes aged 40-49 [compared with population risk]).ConclusionsThis is the first study to provide population based tables of age stratified risk of re-infarction or death for people with diabetes compared with those without diabetes. These tables can be used for giving advice to patients, developing a baseline to compare intervention studies or developing license or health insurance guidelines.

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“…Acute hyperglycemia may attenuate endothelial function, impair coronary microvascular function, activate inflammatory and blood coagulation responses, and increase myocyte apoptosis that exaggerates LV remodeling, all of which may increase the infarct size and cause deterioration of the LV function. 32 Additional well-designed studies need to explore (1) whether similar effects of stress hyperglycemia on the LV may simultaneously affect the RV, and (2) whether the association of admission hyperglycemia with poor outcomes could be, in part, causally related to global RV dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Correlates of Impaired Global Right Ventricular Function in Patients with a Reperfused Acute Myocardial Infarction and without Right Ventricular Infarction

Hsu

Chang

Liu

et al. 2013

Journal of Investigative Medicine

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Hyperglycemia on admission predicts larger infarct size in patients undergoing percutaneous coronary intervention for acute ST-segment elevation myocardial infarction

Cited by 21 publications

References 29 publications

Admission hyperglycemia predicts poorer short‐ and long‐term outcomes after primary percutaneous coronary intervention for ST‐elevation myocardial infarction

Admission hyperglycemia predicts poorer short‐ and long‐term outcomes after primary percutaneous coronary intervention for ST‐elevation myocardial infarction

Population based absolute and relative survival to 1 year of people with diabetes following a myocardial infarction: A cohort study using hospital admissions data

Correlates of Impaired Global Right Ventricular Function in Patients with a Reperfused Acute Myocardial Infarction and without Right Ventricular Infarction

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