Title: Prognostic Value of Acute Hyperglycaemia in Non-Diabetic Acute Myocardial Infarction Patients
Authors: Dr Nishant Sunakarineni, Dr Veena Ramachandran
DOI: http://dx.doi.org/10.18535/jmscr/v4i7.55
In recent years, much attention has been given to the evidence that the concomitant occurrence of hyperglycaemia in patients admitted to intensive care units with an acute myocardial infarction (AMI) enhances the risk of mortality and morbidity, whether the patient was diagnosed with having diabetes or not.1 In some cases, the elevation of glucose levels could simply be a marker of pre-existing, but not yet detected, type 2 diabetes or impaired glucose tolerance (IGT).2 This may mean that besides being causal, elevated glucose also could be a marker of existing insulin resistance and/or beta-cell failure that may contribute to the poor prognosis through other mechanisms. However, a positive association between hyperglycaemia at the time of the event and subsequent mortality from AMI has frequently been reported.3,4,5,6 A strong correlation between glycaemia and shock or development of heart failure has also been reported.7 Consequently, understanding the possible mechanisms through which hyperglycaemia worsens the prognosis of AMI, as well the effectiveness of its control during AMI, seems to be of great relevance. 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; 355: 773–778. 2. Norhammar A, Tenerz A, Nilsson G, Hamsten A, Efendíc S, Rydén L, et al. Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet 2002; 359: 2140–2144. 3. Wahab NN, Cowden EA, Pearce NJ, Gardner MJ, Merry H, Cox JL. ICONS Investigators. Is blood glucose an independent predictor of mortality in acute myocardial infarction in the thrombolytic era? J Am Coll Cardiol 2002; 40: 1748–1754. 4. Stranders I, Diamant M, van Gelder RE, Spruijt HJ, Twisk JW, Heine RJ, et al. Admission blood glucose level as risk indicator of death after myocardial infarction in patients with and without diabetes mellitus. Arch Intern Med 2004; 164: 982–988. 5. Wong VW, Ross DL, Park K, Boyages SC, Cheung NW. Hyperglycemia: still an important predictor of adverse outcomes following AMI in the reperfusion era. Diabetes Res Clin Pract 2004;4: 85–91. 6. Hadjadj S, Coisne D, Mauco G, Ragot S, Duengler F, Sosner P, et al. Prognostic value of admission plasma glucose and HbA1c in acute myocardial infarction. Diabet Med 2004; 1: 05–310. 7. Zeller M, Cottin Y, Brindisi MC, Dentan G, Laurent Y, Janin-Manificat L, et al. Impaired glucose and cardiogenic shock in patients with acute myocardial infarction. Eur Heart J 2004; 355: 308-12. 8. Antman EM, Selwyn AP, Braunwald E, Loscalzo J. Ischemic Heart Disease. In Harrison’s Principles of Internal Medicine. Editors: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J. 18th edition. Mc Graw Hill. Vol 2. 1998-2035. 9. Kadri Z, Danchin N, Vaur L, Cottin Y, Gueret P, Lablanche JM, et al. Major impact of admission glycemia on 30 day and one year mortality in non diabetic patients admitted for myocardial infarction:results from the nationwide French USIC 2000 study. Heart 2006; 92: 910-915. 10. Oswald GA, Smith CC, Betteridge DJ, Y udkin JS. Determinants and importance of stress hyperglycemia in non diabetic patients with myocardial infarction. BMJ 1986; 293: 917-22. 11. Oswald GA, Smith CC, Delamothe AP, Betteridge DJ, Yudkin JS.Raised concentrations of glucose and adrenaline and increased in vivo platelet activation after myocardial infarction. Br Heart J 1988; 59: 663–671. 12. Oliver MF, Kurien VA. Serum-free-fatty-acids and arrhythmias after acute myocardial infarction. Lancet 1969; 2: 1077–1078. 13. Lopaschuk GD, Stanley WC. Glucose metabolism in the ischemic heart. Circulation 1997; 95: 313–315. 14. Taegtmeyer H, McNulty P, Young ME. Adaptation and maladaptation of the heart in diabetes, part I: general concepts. Circulation 2002; 105: 1727–1733. 15. Depre C, Vanoverschelde JL, Taegtmeyer H. Glucose for the heart.Circulation 1999; 99: 578 –588. 16. Ceriello A, Giugliano D, Quatraro A, Dello Russo P, Torella R. Blood glucose may condition factor VII levels in diabetic and normal subjects. Diabetologia 1988; 31: 889–891. Abstract
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