The association of diabetes and admission blood glucose with 30-day mortality in patients with acute myocardial infarction complicated by cardiogenic shock

Abstract

Background Cardiogenic shock is the leading cause of death in patients with acute myocardial infarction, with short-term mortality of approximately 50%. Whether diabetes mellitus and high blood glucose levels are associated with mortality in contemporary patients with acute myocardial infarction complicated by cardiogenic shock is inadequately described. Purpose To investigate if diabetes mellitus and high admission blood glucose were associated with 30-day mortality in a large, contemporary population with acute myocardial infarction complicated by cardiogenic shock. Methods Patients with acute myocardial infarction complicated by cardiogenic shock admitted at two tertiary centres in Denmark from 2010 to 2017 were individually identified through patient charts, resulting in the inclusion of 1716 cardiogenic shock patients. Glucose level at admission to the intensive care unit was available in 1302 patients. Results There was no significant difference in 30-day mortality between diabetes mellitus types I and II (63% vs. 62%, NS). Thirty-day mortality was significantly higher in diabetes patients compared to non-diabetes patients (62% vs. 50%, P < 0.001). Increasing admission glucose was associated with increasing 30-day mortality in a dose-dependent manner in diabetes mellitus (4–8 mmol/L, 41%; 8–12 mmol/L, 49%; 12–16 mmol/L, 63%; >16 mmol/L, 67%; P = 0.028) and non-diabetes patients (4–8 mmol/L, 32%; 8–12 mmol/L, 43%; 12–16 mmol/L, 57%; >16 mmol/l; 68%; P < 0.001). Conclusion Patients with acute myocardial infarction complicated by cardiogenic shock and concomitant diabetes mellitus type I or II had a significantly higher 30-day mortality in comparison to patients without diabetes mellitus, whereas no difference was found between diabetes mellitus types I and II. High glucose levels on admission to the intensive care unit were associated with increased 30-day mortality in diabetes mellitus and non-diabetes mellitus patients.

Correlation between Glycated Haemoglobin Level, Cardiac Function, and Prognosis in Patients with Diabetes Mellitus Combined with Myocardial Infarction

“…Glucose management is the primary goal of patients with diabetes [ 17 ]. Not only does poor blood glucose control increase the risk of retinal, kidney, and microvascular lesions in diabetic patients [ 18 ], but in patients with acute myocardial infarction, adverse fluctuations in blood glucose could exacerbate coronary artery injury [ 19 ]. In this study, diabetic patients with myocardial infarction were divided equally into three groups according to their HbA1c levels.…”

Intervention by clinical pharmacists can improve blood glucose fluctuation in patients with diabetes and acute myocardial infarction: A propensity score‐matched analysis

“…1 AMI patients with DM have a significantly higher mortality than those without diabetes. 2 Many studies have shown a relationship between high blood glucose levels on admission and an increased risk of mortality and poor outcomes after AMI. Studies further verified the association between glucose fluctuation during the phases of AMI and the extent of myocardial salvage.…”

“…DM is being present in nearly 30% of AMI cases 1 . AMI patients with DM have a significantly higher mortality than those without diabetes 2 . Many studies have shown a relationship between high blood glucose levels on admission and an increased risk of mortality and poor outcomes after AMI.…”

Impact of diabetes on outcomes of cardiogenic shock: A systematic review and meta-analysis

“…We analyzed the data from 15 studies. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Specific steps in the process of selection of articles have been detailed in Figure 1. Included studies had an observational study design (Table 1).…”