Prevalence and short-term prognostic implications of admission hyperglycemia in non-diabetic acute myocardial infarction patients

Abstract

Introduction: In patients with acute myocardial infarction, elevation of plasma glucose levels is associated with worse outcomes. Purpose and Objectives: The aim of this study was to evaluate the prevalence of newly hyperglycemia and the association between admission hyperglycemia and in-hospital m ortality in patients with acute myocardial infarction (AMI). Materials and Methods: Retrospective observational study included 125 consecutive patients (<70yo) with AMI hospitalized at “Sfinta Treime” Municipal Hospital, Chisinau, in period 1.01.2012- 31.12.2012. Patients with known diabetes mellitus (n=25) or non-diabetic with fasting hyperglycemia (n=17) were excluded, while those with previous myocardial infarction or stroke were enrolled. The study sample was divided into normoglycemic patients (NDN; n=50; fasting glucose <6.1mmol/l and 2-h post-load glucose <7.8mmol/l) and those with admission hyperglycemia (NDH, n=33), without previous history of diabetes (admission glucose >7.8mmoI/l). Data were analyzed in MS Excel (2010). Results are presented as means and SD. Pearson correlation coefficient (r) was determined for each variable and p<0.05 was considered statistically significant. Results: The results of the present investigation confirm that, even among non-diabetic patients, the prevalence of elevated glucose levels upon admission for AMI is high (n=33; 33%), the prevalence was higher in men (21 vs. 12). Compared to normoglycemic, NDH patients were younger (53.64yo vs. 57.30). As expected, mortality were significant lower in NDN (n=2; 4% vs. n=10; 30%). Mortality was higher in males (7 vs. 3 in NDH; 2 vs. 0 in NDN). In NDH group death occurred predominantly in younger group (9 patients <60yo and 1 person >60yo, compared to 1:1 in NDN). In both groups, admission glucose levels were higher in non-survivors (5.68±1.24 vs. 5.64±0.92 in NDN and 10.85±2.44 vs. 10.13±2.34 in NDH; p<0.001). A strong uphill correlation was observed between admission glucose and mortality (r-coefficient 0.53). NDH had longer hospital stay (456.00±30.99h vs. 426.00h±21.08; p<0.001). Death occurred earlier in NDH (37.66h±15.19 vs. 72.70h, p<0.05). It suggests that the presence of hyperglycemia in subjects who present with AMI offers a survival disadvantage. Conclusions: Hyperglycemia on admission is an independent predictor of poor in-hospital outcome and mortality in AMI and could be used in the stratification of risk in these patients. The impact of hyperglycemia as a risk factor in AMI is more pronounced in younger patients (<60yo) compared to those older than 60yo.