Hypo- and Hyperglycemia Predict Outcome in Patients With Left Ventricular Dysfunction After Acute Myocardial Infarction: Data From EPHESUS

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• 作者：Christian Ukena ; MD¹ ; ^{christian.ukena@uks.eu} ; Daniela Dobre ; MD ; PhD² ; ³ ; Felix Mahfoud ; MD¹ ; Ingrid Kindermann ; MD¹ ; Zohra Lamiral ; MSc² ; Stephane Tala ; MD ; MSc² ; Patrick Rossignol ; MD ; PhD² ; ⁴ ; Eva Turgonyi ; MD⁵ ; Bertram Pitt ; MD⁶ ; Michael B&ouml ; hm ; MD¹ ; Faiez Zannad ; MD ; PhD² ; ⁷
• 关键词：Glucose ; heart failure ; outcome ; prognosis ; cardiovascular risk
• 刊名：Journal of Cardiac Failure
• 出版年：2012
• 期刊代码：162_10719164
• 类别：med
• 出版时间：June, 2012
• 卷：18
• 期：6
• 页码：439-445
• 文件大小：554 K

摘要

Background

Hyperglycemia predicts death in cardiovascular disease, but intensive glucose-lowering strategies increase mortality rates in diabetes. The present analysis investigated the prognostic value of postadmission blood glucose (BG) concentration on clinical outcomes in high-risk patients with heart failure after acute myocardial infarction.

Methods and Results

A total of 6,496 patients from the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) were categorized into 4 groups by plasma glucose concentration: 鈮?.5 mmol/L (hypoglycemia), 4.5-5.5 mmol/L (normoglycemia), 5.5-8.3 mmol/L (elevated glucose level), and >8.3 mmol/L (severe hyperglycemia). We evaluated the time to all-cause death (primary end point) and time to cardiovascular death or hospitalization (secondary end point). Hypo- and severe hyperglycemia were prevalent in 509 (8%) and 1,588 (24%) patients, respectively. There was a U-shaped relationship between BG level and incidence of all-cause death (11.8%in patients with normoglycemia vs 15.1%and 19.9%in those with hypo- and severe hyperglycemia; m>Pm> < .001). The incidence of the secondary end point was increased only in hyperglycemic patients (36%vs 23%in normoglycemic patients; m>Pm> < .001). In multivariate Cox regression analysis, hypoglycemia (hazard ratio [HR] 1.38, 95%confidence interval [CI] 1.06-1.81; m>Pm>聽= .002) and severe hyperglycemia (HR 1.52, CI 1.27-1.83; m>Pm> < .0001) proved to be strong predictors of all-cause death. There was no significant interaction between eplerenone treatment and blood glucose levels regarding clinical outcomes.

Conclusions

In heart failure after acute myocardial infarction, both hypo- and hyperglycemia at the postacute phase identify patients with increased risk of death during long-term follow-up.