[Article in Chinese]
Liu Y, Yang YM, Zhu J, Tan HQ, Liang Y, Liu LS, Li Y.
Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Emergency, Fuwai Hospital, Beijing, China.
OBJECTIVE: To evaluate the predictive value of admission blood glucose level for the mortality within 30-day and major adverse cardiac events(MACE) rate in patients with ST-segment elevation acute myocardial infarction (STEMI). METHODS: An observational analysis of 7446 Chinese STEMI patients from a global randomized controlled trials of cases recruited within 12 hours of symptom onset was carried out. According to the levels of admission glucose (hyperglycemia was defined as admission glucose > 10 mmol/L) and known diagnosis of diabetes mellitus (DM), these patients were divided into four groups, I: no DM and normal glucose group (control group); II: DM but normal glucose group; III: no DM and hyperglycemia group; and IV: DM and hyperglycemia group. RESULTS: Admission hyperglycemia was associated with a significantly higher 30-day mortality rate (group III 17.1% vs group I 8.6%, group IV 18.6% vs group I 8.6%, P < 0.001) and also an increased incidence of MACE (group III 36.3% vs group I 21.6%, group IV 38.8% vs group I 21.6%, P < 0.001). However, DM without admission hyperglycemia did not increase the 30-day mortality (group II 11.6% vs group I 8.6%, P = 0.096). Multivariate logistic regression analysis showed that compared with group I patients, group III and group IV had a risk of death of 1.51 fold ( OR 1.51, 95% CI 1.22-1.87, P <0.001) and 1.83 fold (OR 1.83, 95% CI 1.40-2.39, P <0.001) respectively; hyperglycemia was an independent predictor of 30-day mortality and an increase of 1 mmol/L in glucose level was associated with a 5% increase of mortality risk (OR 1.05, 95% CI 1.04-1.07, P <0.001), but DM without hyperglycemia was not so (OR 1.11, 95% CI 0.87-1.42, P = 0.412). CONCLUSIONS: The rates of 30-day mortality and cardiovascular events are significantly higher in STEMI patients with acute hyperglycemia than in patients without. Hyperglycemia on admission is an independent risk factor for the short-term outcome of STEMI, but diabetes mellitus without hyperglycemia is not associated with the short-term mortality.
PMID: 19954040
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