Hyperglycemia and prognosis of acute myocardial infarction in patients without diabetes mellitus

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Abstract

The present study assessed the prognostic value of hyperglycemia—a common feature in the early phase of acute myocardial infarction (AMI)—in 330 nondiabetic patients. Seventy-nine known diabetics and 10 (3%) unknown diabetics—diagnosed before discharge by stable glycosylated hemoglobin >6.9% and by oral glucose tolerance testing—were excluded. Thirty-three (10%) patients died. The mortality rate was higher in women, in patients with anterior AMI, in older patients (>65 years) and in the presence of heart failure. It was highest in patients with cardiogenic shock (2436 vs 9294; p < 0.0001). Admission plasma glucose was significantly higher in nonsurvivors than in survivors (163 ± 60 vs 114 ± 36 mg/dl; p < 0.0001). Mortality rate increased with increasing admission plasma glucose: 3% in normoglycemic patients (≤ 120 mg/dl) versus 15% in patients with bordeline plasma glucose (121 to 180 mg/dl) versus43% in hyperglycemic patients (>180 mg/dl) (p < 0.0001). Multiple regression (stepwise) analysis identified cardiogenic shock, infarct site and age as the major determinants of mortality, while admission plasma glucose failed to reach full statistical significance (p = 0.067). Hyperglycemia was related to all 3 of these independent prognostic factors; when age and infarct site were accounted for, hyperglycemia was significantly associated with heart failure only and this association was characterized by a remarkable mortality rate. In nondiabetic patients with AMI, hyperglycemia is a correlate of heart failure and, therefore, an important factor of prognosis.

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