Prognostic Implications of Stress Hyperglycemia in Acute ST Elevation Myocardial Infarction. Prospective Observational Study

Sanjuán, Rafael; Núñez, Julio; Blasco, María Luisa; Miñana, Gema; Martínez-Maicas, Helena; Carbonell, Nieves; Palau, Patricia; Bodı́, Vicente; Sanchís, Juan

doi:10.1016/j.rec.2010.08.005

Cited by 32 publications

(42 citation statements)

References 33 publications

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“…However, other authors from Spain and Italy (Mediterranean countries) proposed similar cut-offs (140 mg/ dl and 170 mg/dl, respectively). [23][24][25] Other, Eastern European, countries suggest higher cut-points (≥ 200 mg/dl). 26,27 Probably there is some genetic/environmental explanation for these results and local studies seem to be important.…”

Section: Limitationsmentioning

confidence: 99%

Prognostic impact of admission blood glucose for all-cause mortality in patients with acute coronary syndromes: added value on top of GRACE risk score

Timóteo

Papoila

Rio

et al. 2014

European Heart Journal: Acute Cardiovascular Care

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Background: Abnormal glucose metabolism is a predictor of worse outcome after acute coronary syndrome (ACS). However, this parameter is not included in risk prediction scores, including GRACE risk score. We sought to evaluate whether the inclusion of blood glucose at admission in a model with GRACE risk score improves risk stratification. Methods: Study of consecutive patients included in a single centre registry of ACS. Our primary endpoint was the occurrence of all-cause mortality at one-year follow-up. The ability of the two logistic regression models (GRACE risk score alone and in combination with blood glucose) to predict death was analysed. Continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI), with corresponding 95% confidence intervals (CIs), were also calculated. Results: We included 2099 patients, with a mean age of 64 (SD=13) years, 69% males. In our sample, 55.1% presented with ST-segment elevation ACS and 13.1% in Killip class ≥ 2. Only 25% were known diabetic at admission. In-hospital mortality was 5.8% and 9.7% at one-year follow-up. The best cut-point for blood glucose was 160 mg/dl (sensitivity 62% and specificity 68%), and 35.2% of the patients had increased levels. This group was elderly, had more prevalence of cardiovascular risk factors, worse renal function and GRACE score as well as more frequently Killip class ≥2. Treatment was similar in both groups besides less frequent use of clopidogrel in high glycaemic patients. The hyperglycaemia group had higher one-year mortality (17.2% vs. 5.6%, p<0.001). Moreover, binary blood glucose remained a predictor of death independently of the GRACE risk score and the presence of diabetes (odds ratio (OR) 1.99, 95% CI 1.40–2.84, p<0.001). The inclusion of blood glucose, as a continuous variable, in a logistic regression model with GRACE score, increased the area under the ROC curve from 0.80 to 0.82 (p=0.018) as well as the goodness-of-fit and was associated with an improvement in both the NRI (37%) and the IDI (0.021), suggesting effective reclassification. Conclusions: A blood glucose level on admission ≥ 160 mg/dl is an independent predictor of mortality in medium-term follow-up. It offers an incremental predictive value when added to the GRACE risk score, although with a modest magnitude of improvement, probably due to the high predictive performance of the GRACE risk score alone.

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Section: Limitationsmentioning

confidence: 99%

Prognostic impact of admission blood glucose for all-cause mortality in patients with acute coronary syndromes: added value on top of GRACE risk score

Timóteo

Papoila

Rio

et al. 2014

European Heart Journal: Acute Cardiovascular Care

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“…Many studies indicate that hyperglycemia is associated with adverse outcomes irrespective of diabetes status [1][2][3]. Stress hyperglycemia (SH) is a distinctive clinical feature of critical illness.…”

Section: Introductionmentioning

confidence: 99%

“…Stress hyperglycemia (SH) is a distinctive clinical feature of critical illness. SH in a setting of acute myocardial infarction (AMI) increases the risk of malignant ventricular arrhythmias as well as in-hospital mortality [2]. Few studies have examined the association between hyperglycemia and adverse outcomes in patients with ST-segment elevation myocardial infarction (STE-MI) treated with a primary percutaneous coronary intervention (p-PCI), but the relationship between SH and in-hospital ST has rarely been reported.…”

Section: Introductionmentioning

confidence: 99%

Impact of stress hyperglycemia on in-hospital stent thrombosis and prognosis in nondiabetic patients with ST-segment elevation myocardial infarction undergoing a primary percutaneous coronary intervention

Zhang

Zhou

Cao

et al. 2013

Coronary Artery Disease

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“…Nonlinear regression model showed that duration of diabetes, cardiac autonomic neuropathy, and left ventricular posterior wall were the strongest independent parameters of LVPs occurrence. An association between hyperglycemia on admission in patients with acute ST elevation MI and arrhythmias during hospitalization has been observed (Sanjuan et al, 2011). Stress hyperglycemia on admission was found to be a predictor of mortality and arrhythmias in patients with acute ST elevation MI and could be used in the stratification of risk in these patients (Pinto et al, 2008;Sanjuan et al, 2011).…”

Section: Diabetes Mellitus and Hyperglycemiamentioning

confidence: 99%

Late Ventricular Potentials in Cardiac and Extracardiac Diseases

Mozoş¹,

Şerban²,

Mihăescu³

2012

Cardiac Arrhythmias - New Considerations

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Prognostic Implications of Stress Hyperglycemia in Acute ST Elevation Myocardial Infarction. Prospective Observational Study

Cited by 32 publications

References 33 publications

Prognostic impact of admission blood glucose for all-cause mortality in patients with acute coronary syndromes: added value on top of GRACE risk score

Prognostic impact of admission blood glucose for all-cause mortality in patients with acute coronary syndromes: added value on top of GRACE risk score

Impact of stress hyperglycemia on in-hospital stent thrombosis and prognosis in nondiabetic patients with ST-segment elevation myocardial infarction undergoing a primary percutaneous coronary intervention

Late Ventricular Potentials in Cardiac and Extracardiac Diseases

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