In-hospital daily insulin dose predicts long-term adverse outcome in patients with diabetes with ST‑elevation myocardial infarction treated with successful primary percutaneous angioplasty

Abstract

IntroductionEarly initiation of reperfusion therapy including primary percutaneous coronary revascularization (PPCI) has been recognized as a crucial factor determining clinical outcomes in the acute phase of myocardial infarction. In unstable patients with type 2 diabetes mellitus (T2D) the clear benefit from PPCI was proven. We aim to evaluate the prognostic value of factors describing glycometabolic state on admission in patients with T2D undergoing PPCI in acute ST-elevation myocardial infarction (STEMI).Material and methodsProspective analysis of clinical and laboratory variables (mean daily short acting exogenous insulin dose (DID), admission blood glucose, glycated hemoglobin (HbA1c), microalbuminuria) was performed in 112 consecutive patients with T2D with STEMI who underwent PPCI. Women comprised 58% of the group.ResultsInsulin dosing was targeted to obtain a mean daily glucose level < 7.8 mmol/l. During 12-month follow-up 33 (29.5%) major adverse cardiac events (major adverse cardiac events (MACE) consisting of death, reinfarction, and repeated target vessel revascularization) were reported. Microalbuminuria was present in 68 (60.5%) patients. The mean HbA1c level was 7.9%. In the multivariate logistic regression model only DID > 44 IU remained an independent risk factor for MACE (p = 0.02, OR = 5.2).ConclusionsIn patients with diabetes with STEMI treated with PPCI, simple measurement of DID during hospitalization can add valuable prognostic information about the future risk of MACE.

The rs2228145 polymorphism in the interleukin-6 receptor and its association with long-term prognosis after myocardial infarction in a pilot study

“…Therefore, every effort is being made to improve not only therapy but also risk stratification. Novel parameters helpful in the assessment of prognosis are continuously searched for [31–33]. High-risk patients require more intensive ambulatory monitoring and more aggressive treatment.…”

Acute myocardial infarction due to left main coronary artery disease in men and women: does ST-segment elevation matter?

“…ostial vs. bifurcation) or stenting strategy. Neither vascular access site selection nor any sophisticated parameters were considered, although they are also known to impact the mortality, as it has been recently reported [ 26 , 27 ]. Mortality data, although obtained for all cases included, did not distinguish between cardiovascular and all-cause mortality.…”