Abstract
Patients either with or without a prior history of diabetes mellitus may present with hyperglycemia during acute myocardial infarction (AMI); it is uncertain whether hyperglycemia upon admission, irrespective of the diagnosis of diabetes, remains an independent predictor of in-hospital morbidity and mortality.
Aim of the study
We aimed in this study to assess the impact of admission blood glucose level on the hospital course and outcome in non diabetic patients presenting with STEMI
Patients and methods
We included 100 non diabetic patients with STEMII divided into two groups: group I included 45 patients with admission blood glucose level less than 180 mg/dl and group II included 55 patients with admission blood glucose level 180 mg/dl or more. All patients were subjected to complete history taking and complete clinical examination; 12-lead ECG was performed for every patient and routine laboratory investigations including cardiac enzymes, admission blood glucose level, and HbA1c were estimated at the time of admission of the patients.
Results
There was significant correlation between admission blood glucose level and history of smoking . There was also significant correlation between admission blood glucose level and complications of myocardial infarction including sinus tachycardia, arrhythmia, and ICU length of stay . However, HbA1c level was not found to be correlated with any of the previous parameters.
Conclusion
We concluded that elevated admission glucose level is a strong predictor of short-term adverse outcome in patients with AMIs. However, the prognostic value of diabetic control (i.e. hemoglobin A1c levels) in patients with AMI is still undefined.
References
1. Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes. a systematic overview. Lancet 2000; 356:773–778.
2. Norhammer AM, Ryden L, Malmberg K. Admission plasma glucose. Independent risk factor for long-term prognosis after myocardial infarction even in nondiabetic patients. Diabetes Care 1999; 22:1827–1831.
3. Sewardsen M, Vythilingum S, Jialal I, Becker PJ. Prognostic importance of admission plasma glucose in diabetic and non-diabetic patients with acute myocardial infarction. Q J Med 1989; 265:461–466.
4. Hammoud T, Tanguay JF, Bourassa MG. Management of coronary artery disease. Therapeutic options in patients with diabetes. J Am Coll Cardiol 2000; 36:355–365.
5. Bartnik M, Malmberg K, Norhammar A, Tenerz A, Ohrvik J, Ryde’n L. Newly detected abnormal glucose tolerance: an important predictor of long-term outcome after myocardial infarction. Eur Heart J 2004; 25:1990–1997.
6. Zeller M, Cottin Y, Brindisi MC. RICO Survey Working Group. Impaired fasting glucose and cardiogenic shock in patients with acute myocardial infarction. Eur Heart J 2004; 25:308–312.
7. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of longterm complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329:977986.
8. Adler AI, Stratton IM, Neil HA, Yudkin JS, Matthews DR, Cull CA, et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ 2000; 321:412.
9. Sacks DB, Bruns DE, Goldstein DE, Maclaren NK, McDonald JM, Parrott M. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem 2002; 48:436–472.
10. Gorus F, Mathieu C, Gerlo E. How should HbA1c measurements be reported? Diabetologia 2006; 49:7–10.
11. The NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009; 360:1283– 1297.
12. M Cakmak, N Cakmak, S Cetemen, H Tanriverdi, Y Enc, O Teskin, ID Kilic. The value of admission glycosylated hemoglobin level in patients with acute myocardial infarction. Can J Cardiol 2008; 24:375–378.
13. Pres D, Gasior M, Lekston A, Gierlotka M, Hawranek M, Tajstra M, Buchta P, et al. Relationship between low-density lipoprotein cholesterol level on admission and in-hospital mortality in patients with ST-segment elevation myocardial infarction, with or without diabetes, treated with percutaneous coronary intervention. Kardiol Pol 2010; 68:1005–1012.
14. Gasior M, Stasik-Pres G, Pres D, Lech P, Gierlotka M, Lekston A, et al. Relationship between blood glucose on admission and prognosis in patients with acute myocardial infarction treated with percutaneous coronary intervention. Kardiol Pol 2007; 65:1031–1038. discussion 1039–1040
15. M Kosiborod, DK McGuire. Glycated hemoglobin as a prognostic risk marker in nondiabetic patients after acute myocardial infarction. Circulation 2011; 124:666–668.
16. Jorik Rudolf Timmer, Clinical implications of glycometabolic disturbances in acute coronary syndromes / Jorik Rudolf Timmer.(S.l.:s.n.), 2005 (Ensch ede):Febodruk).- 203 p.: ill.; 24 cm.
17. CY Chan, R Li, JY Chan, et al. The value of Admission HbA1c level in diabetic patients with acute coronary syndrome. Clin Cardiol 2011; 34:507–512.
18. Y Liu, Y-M Yang, J Zhu, H-Q Tan, Y Liang, JD Li. Prognostic significance of hemoglobin A1c level in patients hospitalized with coronary artery disease. A systematic review and meta-analysis. Cardiovasc Diabetol 2011; 10:98.
19. DeGeare VS, Boura JA, Grines LL, O’Neill WW, Grines CL. Predictive value of the Killip classification in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol 2001;87:1035–1038.
20. Gosselink AT, Liem AL, Reiffers S, Zijlstra F Prognostic value of predischarge radionuclide ventriculography at rest and exercise after acute myocardial infarction treated with thrombolytic therapy or primary coronary angioplasty. The Zwolle Myocardial Infarction Study Group. Clin Cardiol 1998; 21:254–260.
21. Levetan CS, Passaro M, Jablonski K, Kass M, Ratner RE. Unrecognized diabetes among hospitalized patients. Diabetes Care 1998; 21:246–249.
22. Li D, Zhao L, Liu M, et al. Kinetics of tumor necrosis factor alpha in plasma and the cardioprotective effect of a monoclonal antibody to tumor necrosis factor alpha in acute myocardial infarction. Am Heart J 1999; 137:1145– 1152.
23. Fujita H, Morita I, Murota S. A possible involvement of ion transporter in tumor necrosis factor alpha and cycloheximide-induced apoptosis of endothelial cells. Mediators Inflamm 1999; 8:211218.