Title: An Observational Study on Prognostic Significance of Admission Blood Glucose Level in ST Elevation Myocardial Infarction
Authors; Dr Ganesh.K, Prof. Dr S.Balasubramaniyan.M.D., Dr N.Paari M.D.
DOI: https://dx.doi.org/10.18535/jmscr/v7i10.110
Abstract
Aims and Objectives: To determine the prognostic significance of admission blood glucose level among nondiabetic patients presenting with ST elevation myocardial infarction (STEMI).
Method: This is a prospective observational study conducted from November 2017 to October 2019. A total of 100 consecutive patients admitted with ST elevation myocardial infarction in CCU, RMMCH were included after satisfying the inclusion and exclusion criteria. All the patients were subjected to complete history taking and clinical examination. Investigations like ECG, cardiac enzyme, admission blood glucose, HbA1c, Echocardiogram were done in all patients. Patients in the study were divided into three groups i.e. Group A (patients with blood glucose level <140 mg/dl), Group B (patients with blood glucose level between 140 and 200 mg/dl), Group C (patients with blood glucose level >200 mg/dl). Group A had 21 participants group B had 42 and Group C 37.
Results
- In this study among those who developed cardiogenic shock 66.7 % were in the group C, and 33.3 % were in group B and no patient in Group A.
- Among those who developed pulmonary edema 66.7% were in the Group C, and 26.7 % were in group B and in Group A 6.7%.
- Among those who developed arrhythmias 54.5% were in the Group C, and 27.3% were in group B and in Group A 18.2%.
- Among those patients who had ejection fraction of <40%, 6% were in Group C
- In total 4 patients died before hospital discharge, of them 3 belong to Group C and one belong to Group B.
Conclusion: From the above observations it has been concluded that hyperglycemia at the time of admission is very common in patients presenting with ST elevation myocardial infarction. It is associated with greater myocardial injury and an increased risk of major adverse cardiovascular events. Therefore in all patients with STEMI random blood sugar level should be estimated at the time of admission which will predict cardiovascular complications and could be used in the risk stratification of these patients.
Keywords: Admission blood glucose, ST elevation myocardial infarction, adverse cardiovascular events.
References
- Rafael Sanjua n,, Julio Nu n ez, M. Luisa Blasco, Gema Minana, Helena Martı´nez-Maicas, Nieves Carbonell, Patricia Palau, Vicente Bodı, and Juan Sanchis Prognostic Implications of Stress Hyperglycemia in Acute ST Elevation Myocardial Prospective Observational Study, 2011;64(3):201–207.
- Kosiborod M, Rathore SS, Inzucchi SE, Masoudi FA, Wang Y, Havranek EP, et al. Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized Circulation. 2005;11:3078–86.
- Metha SR, Yusuf S, Diaz R, Zhu J, Pais P, Xavier D, et al. Effect of glucose-insulinpotassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction: the CREATE-ECLA randomized controlled trial. JAMA. 2005; 293: 437–46.
- Masaharu Ishihara, Acute Hyperglycemia in Patients with Acute Myocardial Infarction. Circulation Journal Official Journal of the Japanese Circulation Society, Vol.76, March 2012.
- Yang et al. Prognostic value of admission blood glucose level in patients with and without diabetes mellitus who sustain ST segment elevation myocardial infarction complicated by cardiogenic shock.Critical Care 2013, 17:R218.
- 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
- M Kosiborod, DK McGuire. Glycated hemoglobin as a prognostic risk marker in nondiabetic patients after acute myocardial Circulation 2011; 124:666–668.
- Hanan E. Zaghlaa, Mahmoud A. Elbadryb, Alaa M. Ashourc, Mohamed M. Abdelfatahd. Influence of admission blood glucose and hemoglobin A1c on outcome of acute myocardial infarction. The Egyptian Society of Internal Medicine 2014, 26:21–26.