Admission Hyperglycemia Is an Independent Predictor for In Hospital Death in Acute Myocardial Infarction in both Diabetes Mellitus and non Diabetes Mellitus Patients
1Korea University Ansan Hospital, Ansan, Korea (Republic of); 2Chonnam national university hospital, Gwangju, Korea (Republic of); 3Yeungnam University Hospital , Daegu, Korea (Republic of); 4Kyungpook National University Hospital, Daegu, Korea (Republic of); 5Busan National University Hospital, Busan, Korea (Republic of); 6Chungnam National University Hospital, Daejon, Korea (Republic of); 7Chunbuk National University Hospital, Jeonju, Korea (Republic of); 8Kyung Hee University Hospital, Seoul, Korea (Republic of); 9Chungbuk National University Hospital, Cheongju, Korea (Republic of); 10Catholic University Hospital, Seoul, Korea (Republic of); 11Asan Medical Center, Seoul, Korea (Republic of)
Background: The aim of this study was to assess the relationship between glucose level at admission and prognosis in patients with acute myocardial infarction(AMI)
Methods: A total of 7,209 AMI patients were enrolled between Nov. 2005 and Jan. 2008. The patients were divided into two groups according to admission serum glucose levels: group I (<200 mg/dL, n=5,502), and group II (>200mg/dL, n=1,707). Incidence of MACE (death, MI, target lesion revascularization) in in-hospital, 1 month, 6 months and 12 moths were compared between the groups.
Results: There were no significant differences in clinical characteristics between the groups except the incidence of diabetes mellitus (DM). Incidence of DM was 1,056 (19.2%) in group I and 887 (52%) in group II(p<0.001). The patients who underwent PCI were 4, 674 (85%) in group I and 1,431(83.8%) in group II (p=NS). Group II showed significantly higher in-hospital mortality than group I (p<0.001) and in-hospital mortality showed progressively increased with higher tertiles of elevated serum glucose level at admission. But there were no significant differences in incidence of MACE at 1month, 6 months and 12 months follow up. After multiple regression analysis including clinical characteristics, PCI and success of PCI, etc, the acquisition of final TIMI 3 flow after PCI (p=0.001, OR 0.26, C.I. 0.13-0.49) and presence of hyperglycemia at admission (p=0.005, OR 2.25, C.I. 1.28-3.95) were the independent predictor of in hospital death.
Conclusion: We found significant association between admission glucose levels and in-hospital mortality in a large cohort of patients with AMI. Our findings suggest that we should pay more attention to control the hyperglycemia at admission even in non-diabetic patient.
