Major impact of admission glycaemia on 30 day and one year mortality in non-diabetic patients admitted for myocardial infarction: results from the nationwide French USIC 2000 study

Kadri, Zena; Danchin, Nicolás; Vaur, L; Cottin, Yves; Guéret, Pascal; Zeller, Marianne; Lablanche, Jean‐Marc; Blanchard, Didier; Hanania, G; Genès, N; Cambou, Jean-Pierre

doi:10.1136/hrt.2005.073791

Cited by 77 publications

(64 citation statements)

References 26 publications

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“…Also, despite the lower blood This is the first study to assess the association of glycemic state upon hospital admission with the myocardium area at risk and myocardial salvage in a large cohort of patients with STEMI. Our data suggest that the excessive myocardial damage (5-8) and adverse prognosis (3,5,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) reported in patients with hyperglycemia are the results of a larger myocardial area at risk, and not of a smaller myocardial salvage. Similarly, since there was no association between hyperglycemia and infarct size when adjusting for the area at risk, the current study demonstrates that the association between hyperglycemia and infarct size is dependent on the size of the area at risk, and hyperglycemic patients can therefore be considered to be at higher risk per se.…”

Section: Discussionmentioning

confidence: 83%

“…The mechanisms behind reperfusion injury have not been fully elucidated, but hyperglycemia, which is observed in approximately half of patients with STEMI upon hospital admission (3), may be unfavorable during reperfusion and has been linked to the subsequent injury (4). Previous studies have demonstrated larger infarct size (5)(6)(7)(8) and poorer prognosis in patients with hyperglycemia upon hospital admission compared with patients without hyperglycemia, both in patients with and without diabetes mellitus (3,5,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Until now, the impact of hyperglycemia on myocardial salvage has been evaluated in only a limited number of patients (21), and no data exist regarding the relationship between hyperglycemia and area at risk.…”

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confidence: 99%

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Impact of Acute Hyperglycemia on Myocardial Infarct Size, Area at Risk, and Salvage in Patients With STEMI and the Association With Exenatide Treatment: Results From a Randomized Study

et al. 2014

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Hyperglycemia upon hospital admission in patients with ST-segment elevation myocardial infarction (STEMI) occurs frequently and is associated with adverse outcomes. It is, however, unsettled as to whether an elevated blood glucose level is the cause or consequence of increased myocardial damage. In addition, whether the cardioprotective effect of exenatide, a glucose-lowering drug, is dependent on hyperglycemia remains unknown. The objectives of this substudy were to evaluate the association between hyperglycemia and infarct size, myocardial salvage, and area at risk, and to assess the interaction between exenatide and hyperglycemia. A total of 210 STEMI patients were randomized to receive intravenous exenatide or placebo before percutaneous coronary intervention. Hyperglycemia was associated with larger area at risk and infarct size compared with patients with normoglycemia, but the salvage index and infarct size adjusting for area at risk did not differ between the groups. Treatment with exenatide resulted in increased salvage index both among patients with normoglycemia and hyperglycemia. Thus, we conclude that the association between hyperglycemia upon hospital admission and infarct size in STEMI patients is a consequence of a larger myocardial area at risk but not of a reduction in myocardial salvage. Also, cardioprotection by exenatide treatment is independent of glucose levels at hospital admission. Thus, hyperglycemia does not influence the effect of the reperfusion treatment but rather represents a surrogate marker for the severity of risk and injury to the myocardium.

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Section: Discussionmentioning

confidence: 83%

mentioning

confidence: 99%

Impact of Acute Hyperglycemia on Myocardial Infarct Size, Area at Risk, and Salvage in Patients With STEMI and the Association With Exenatide Treatment: Results From a Randomized Study

et al. 2014

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“…R ecent studies have emphasized the prognostic value of high blood glucose levels in patients with acute myocardial infarction (AMI) (1)(2)(3)(4)(5)(6). Previous investigations focused on the relationship between random blood glucose on admission and outcome.…”

Section: Diabetes Care 30:960 -966 2007mentioning

confidence: 99%

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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“…12,13,14,15 Alternatively, elevated blood glucose levels per se adversely affect outcome through the cumulative effects of several mechanisms, including induction of endothelial dysfunction, 16 oxidative stress, 7,8 hypercoagulability, and impaired fibrinolysis . 9 Lastly, admission hyperglycemia may not be only the cause of more severe myocardial damage, but also its consequence. Large infarcts are more likely to cause catecholamine release, which affect fatty acid and glucose homeostasis.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Acute Hyperglycaemia in Non-Diabetic Acute Myocardial Infarction Patients

Sunakarineni¹,

Ramachandran²

2016

jmscr

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Major impact of admission glycaemia on 30 day and one year mortality in non-diabetic patients admitted for myocardial infarction: results from the nationwide French USIC 2000 study

Cited by 77 publications

References 26 publications

Impact of Acute Hyperglycemia on Myocardial Infarct Size, Area at Risk, and Salvage in Patients With STEMI and the Association With Exenatide Treatment: Results From a Randomized Study

Impact of Acute Hyperglycemia on Myocardial Infarct Size, Area at Risk, and Salvage in Patients With STEMI and the Association With Exenatide Treatment: Results From a Randomized Study

Fasting Glucose in Acute Myocardial Infarction

Prognostic Value of Acute Hyperglycaemia in Non-Diabetic Acute Myocardial Infarction Patients

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