Coronary artery disease
Impact of Admission Hyperglycemia and Diabetes Mellitus on Short- and Long-Term Mortality After Acute Myocardial Infarction in the Coronary Intervention Era

https://doi.org/10.1016/j.amjcard.2007.01.044Get rights and content

The influence of admission hyperglycemia and diabetes on short- and long-term mortality of patients with acute myocardial infarction (AMI) in the percutaneous coronary intervention (PCI) era was investigated. From 1996 to 2003, a total of 802 consecutive patients with AMI underwent coronary angiography. Primary PCI was performed in 724 patients (90%). Three-year mortality curves were constructed using the Kaplan-Meier method. Cox proportional hazard regression was used to identify independent predictors of 30-day mortality and mortality from 30 days to 3 years. There were 261 patients with admission hyperglycemia (admission glucose ≥11.1 mmol/L) and 212 patients with diabetes. Admission hyperglycemia was associated with a significantly higher 30-day mortality rate (8.4% vs 2.4%, p <0.001). However, there was no significant difference in 30-day mortality rates between diabetic and nondiabetic patients (5.7% vs 3.9%, p = 0.29). Conversely, diabetes significantly increased mortality from 30 days to 3 years (10.0% vs 5.5%, p = 0.03), but admission hyperglycemia did not (8.4% vs 5.9%, p = 0.19). Multivariate analysis showed that hyperglycemia was an independent predictor of 30-day mortality (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.13 to 2.61, p = 0.01), but diabetes was not (OR 0.84, 95% CI 0.55 to 1.27, p = 0.42). Diabetes was independently associated with mortality from 30 days to 3 years (OR 1.43, 95% CI 1.02 to 1.97, p = 0.04), but hyperglycemia had a neutral effect (OR 0.98, 95% CI 0.70 to 1.36, p = 0.92). In conclusion, in the PCI era, admission hyperglycemia was associated with short-term mortality, whereas diabetes increased long-term mortality after convalescence in patients with AMI. Admission hyperglycemia and diabetes should be treated as 2 distinct disease states.

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Methods

From January 1996 to December 2003, a total of 802 consecutive patients with AMI underwent coronary angiography within 24 hours after the onset of chest pain at Hiroshima City Hospital, Hiroshima, Japan. AMI was diagnosed as chest pain consistent with ongoing myocardial ischemia persisting >30 minutes with concomitant electrocardiographic changes. Serum creatine kinase was measured every 3 hours for at least 24 hours, and peak creatine kinase had to be more than twice the normal upper limit.

Results

There were 261 patients (32%) with admission hyperglycemia. Baseline clinical and angiographic characteristics of patients with and without admission hyperglycemia are listed in Table 1. Baseline characteristics of diabetic and nondiabetic patients are listed in Table 2. There were 212 patients (26%) with diabetes. Ninety-seven patients (46%) were treated with diet only; 94 patients (44%), with oral hypoglycemic drugs; and 21 patients (10%), with insulin. Peak creatine kinase was obtained in

Discussion

This study showed that both admission hyperglycemia and diabetes increased 3-year mortality after AMI in the contemporary PCI era. However, influences of admission hyperglycemia and diabetes on mortality were different and time dependent. Admission hyperglycemia increased mortality markedly during the first 30 days, then mortality leveled off in both diabetic and nondiabetic patients. In patients without admission hyperglycemia, 30-day mortality was low regardless of diabetic status. However,

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