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

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• 作者：Rafael Sanjuá ; n^a ; ^{sanjuan_raf@gva.es} ; Julio N&#xfa ; &#xf1 ; ez^b ; M. Luisa Blasco^a ; Gema Mi&#xf1 ; ana^b ; Helena Martí ; nez-Maicas^a ; Nieves Carbonell^a ; Patricia Palau^b ; Vicente Bodí ; ^b ; Juan Sanchis^b
• 关键词：Acute myocardial infarction ; Diabetes mellitus ; Arrhythmias ; Bundle branch block
• 刊名：Revista Española de Cardiología (English Edition)
• 出版年：2011
• 出版时间：March 2011
• 年：2011
• 卷：64
• 期：3
• 页码：201-207
• 全文大小：177 K

文摘

Introduction and objectives

In patients with acute myocardial infarction, elevation of plasma glucose levels is associated with worse outcomes. The aim of this study was to evaluate the association between stress hyperglycemia and in-hospital mortality in patients with acute myocardial infarction with ST-segment elevation (STEMI).

Methods

We analyzed 834 consecutive patients admitted for STEMI to the Coronary Care Unit of our center. Association between admission glucose and mortality was assessed with Cox regression analysis. Discriminative accuracy of the multivariate model was assessed by Harrell's C statistic.

Results

Eighty-nine (10.7 % ) patients died during hospitalization. Optimal threshold glycemia level of 140 mg/dl on admission to predict mortality was obtained by ROC curves. Those who presented glucose ≥140 mg/dl showed higher rates of malignant ventricular tachyarrhythmias (28 % vs. 18 % , P = .001), complicative bundle branch block (5 % vs. 2 % , P = .005), new atrioventricular block (9 % vs. 5 % , P = .05) and in-hospital mortality (15 % vs. 5 % , P < .001). Multivariate analysis showed that those with glycemia ≥140 mg/dl exhibited a 2-fold increase of in-hospital mortality risk (95 % CI: 1.2-3.5, P = .008) irrespective of diabetes mellitus status (P-value for interaction = 0.487 and 0.653, respectively).

Conclusions

Stress hyperglycemia on admission is a predictor of mortality and arrhythmias in patients with STEMI and could be used in the stratification of risk in these patients.