Reference: Planer et al. International Journal of Cardiology 2012 (in press)
Prognosis of patients enrolled in acute myocardial infarction with ST segment elevation (STEMI) has improved markedly, particularly as a result of reperfusion therapy. Despite these improvements, patients with diabetes mellitus (DM) are a high risk group in the short and long term compared with patients without DM. Epidemiological studies found increased micro and macro vascular complications with blood glucose levels lower than those defined for the diagnosis of DM (“IGT”). New studies show that patients without DM but admitted with diagnosis of STEMI hyperglycemic, 40% were glucose intolerant and only 25% were undiagnosed DM.
Hyperglycemia on admission is associated with increased morbidity and mortality in the short follow-up, as well as with the follow-up of patients without DM. However, most of its predictive information comes from large studies of thrombolytic era, although data available from patients.
A recent sub-analysis (n = 3400 patients, 566 DM) of HORIZON-AMI randomized study evaluated the prognostic power of fasting glucose prior to primary angioplasty in patients with STEMI. Authors stratified patients according tertiles fasting glucose level. The median blood glucose of the total population was 138.0 mg / dl [interquartile 115.4, 171.0]. 30 day adjusted mortality was higher in the upper tertile blood glucose (relative risk [95% confidence interval] = 3.53 [1.89, 6.60], p <0.0001), both in DM patients (4.40 [2.04, 9.50], p = 0.0002) and non-DM patients (3.33 [1.16, 9.55], p = 0.03). The cut-off value for predicting blood glucose 30 day mortality was 169 mg / dl (ROC curve = 0.69), 149 mg / dl for non-DM (ROC curve = 0.77) and 231 mg / dl for DM (AUC = 0.69). In addition, basal hyperglycemia was an independent predictor of mortality at 3 years (1.93 [1.35, 2.76], P = 0.0003), in DM (2.65 [1.28, 5.47], P = 0.008) and in non-DM (1.58 [1.05, 2.36], P = 0.03).
Conclusion: In patients with STEMI referred for primary angioplasty, the presence of hyperglycemia on admission is an independent predictor of mortality in the short and long term in patients with or without DM.
Comment: This retrospective study is the first to provide cut-off values