Acute hyperglycemia is associated with adverse outcome after acute myocardial infarction in the coronary intervention era

Received 25 February 2004; accepted 23 December 2004.

Purpose

This study was undertaken to assess the association between acute hyperglycemia and inhospital outcome after acute myocardial infarction (AMI) in the percutaneous coronary intervention (PCI) era. We also assessed outcome of patients with a history of diabetes mellitus in the PCI era.

Methods

Between January 2001 and December 2001, 1253 patients were admitted to the hospitals within 48 hours after the onset of AMI. Plasma glucose was measured at hospital admission. Acute hyperglycemia was defined as plasma glucose of >11 mmol/L (198 mg/dL), regardless of the diabetic status. Primary PCI was performed in 898 (72%) patients.

Results

The inhospital mortality rate was significantly higher in patients with acute hyperglycemia than in patients without (16% vs 6%, P < .001). However, there was no significant difference in mortality between diabetic and nondiabetic patients (8% vs 9%, P = .54). Acute hyperglycemia was associated with a higher inhospital mortality rate both in nondiabetic patients (24% vs 6%, P < .001) and in diabetic patients (10% vs 5%, P = .039). Acute hyperglycemia was associated with a higher incidence of no reflow during PCI (21% vs 12%, P < .001), but diabetes was not (14% vs 15%, P = .71).

Conclusion

Acute hyperglycemia, but not diabetes, was a predictor for inhospital mortality after AMI in the PCI era. No reflow occurred more frequently during PCI in patients with acute hyperglycemia, suggesting that microvascular dysfunction might have contributed to adverse outcome of these patients.

a Department of Cardiology, Hiroshima City Hospital

b Department of Cardiovascular Medicine, Kumamoto University School of Medicine

c First Department of Pathology, Miyazaki Medical College

d The First Department of Internal Medicine, Kagoshima University Faculty of Medicine

e Division of Cardiology, Yokohama City University Medical Center

f Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center

g The Second Department of Cardiology, National Hospital Kyusyu Cardiovascular Center

h Second Department of Internal Medicine, Sapporo Medical University School of Medicine

i Department of Pathology, National Cardiovascular Center

j Department of Microbiology, School of Medicine, Yamaguchi University

k Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University

l Division of Cardiology, Oita National Hospital

m Department of Cardiology, Nihon University Surugadai Hospital

Reprint requests: Masaharu Ishihara, MD, PhD, Department of Cardiology, Hiroshima City Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima 730-8518, Japan.

This study was supported by the Research Grant for Cardiovascular Disease (14C-4) from the Ministry of Health, Labor, and Welfare.

⁎ See Appendices.

PII: S0002-8703(05)00005-0

doi:10.1016/j.ahj.2004.12.020

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