Original investigation

Persistent hyperglycemia is an independent predictor of outcome in acute myocardial infarction

Iwan CC van der Horst¹ , Maarten WN Nijsten² , Mathijs Vogelzang¹ and Felix Zijlstra¹

¹  Department of Cardiology, University of Groningen Medical Center, University of Groningen, The Netherlands

²  Intensive Care Medicine, University of Groningen Medical Center, University of Groningen, The Netherlands

author email corresponding author email

Cardiovascular Diabetology 2007, 6:2doi:10.1186/1475-2840-6-2

Published:	6 February 2007

Abstract

Background

Elevated blood glucose values are a prognostic factor in myocardial infarction (MI) patients. The unfavourable relation between hyperglycemia and outcome is known for admission glucose and fasting glucose after admission. These predictors are single measurements and thus not indicative of overall hyperglycemia. Increased persistent hyperglycemia may better predict adverse events in MI patients.

Methods

In a prospective study of MI patients treated with primary percutaneous coronary intervention (PCI) frequent blood glucose measurements were obtained to investigate the relation between glucose and the occurrence of major adverse cardiac events (MACE) at 30 days follow-up. MACE was defined as death, recurrent infarction, repeat primary coronary intervention, and left ventricular ejection fraction equal to or smaller than 30%.

Results

MACE occurred in 89 (21.3%) out 417 patients. In 17 patients (4.1%) it was a fatal event. A mean of 7.4 glucose determinations were available per patient. Mean +/- SD admission glucose was 10.1 +/- 3.7 mmol/L in patients with a MACE versus 9.1 +/- 2.7 mmol/L in event-free patients (P = 0.0024). Mean glucose during the first two days after admission was 9.0 +/- 2.8 mmol/L in patients with MACE compared to 8.1 +/- 2.0 mmol/L in event free patients (P < 0.0001). The area under the receiver operator characteristic curve was 0.64 for persistent hyperglycemia and 0.59 for admission glucose. Persistent hyperglycemia emerged as a significant independent predictor (P < 0.001).

Conclusion

Persistent hyperglycemia in MI has a stronger relation with 30-day MACE than elevated glucose at admission.