The impact of plasma glucose levels on in-hospital and long-term mortality in non-diabetic patients with ST-segment elevation myocardial infarction patients

Yıl 2020, Cilt: 12 Sayı: 1, 55 - 60, 02.03.2020

Mustafa Adem Tatlısu , Adnan Kaya , Muhammed Keskin , Ömer Kozan

https://doi.org/10.18521/ktd.458229

Öz

Objective: Increased admission plasma glucose can be seen in the acute phase of acute coronary syndromes (ACS). Hence, we performed a retrospective study to evaluate the admission plasma glucose concentration in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) and who had no previous diagnosis of Diabetes Mellitus (DM).

Method: This retrospective study included 2504 consecutive confirmed STEMI patients treated with pPCI. The patients were divided into quantiles according to the admission glucose levels. Quantile I: 94 ± 7 mg/dL (n= 626), quantile II: 112 ± 5 mg/dL (n = 626), quantile III: 131 ± 6 mg/dL (n= 626), quantile IV: 184 ± 46 mg/dL (n= 626).

Results: Patients with higher plasma glucose (Q4) had 6.6 times higher in-hospital all-cause mortality rates (95% CI: 3.95–9.30) and 3.12 times higher (95% CI: 2.2–4.4) long-term all-cause mortality rates than patients with lower plasma glucose (Q1–Q3), who had lower rates and were used as the reference. This significant relationship remained even after adjustment for all confounders.

Conclusion: Even though glucose-lowering therapy is recommended in ACS patients with glucose levels >180 mg/dL, our results showed that high plasma glucose, even lower than 180 mg/dL, could predict in-hospital and long-term mortality.

Anahtar Kelimeler

ST-segment elevation myocardial infaction, hyperglycemia, long-term mortality

Kaynakça

• 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: 773–78.
• 2) Wahab NN, Cowden EA, Pearce NJ, Gardner MJ, Merry H, Cox JL, et al. Is blood glucose an independent predictor of mortality in acute myocardial infarction in the thrombolytic era? J Am Coll Cardiol 2002; 40: 1748–54.
• 3) Ishihara M, Kojima S, Sakamoto T, Asada Y, Tei C, Kimura K, et al. Acute hyperglycemia is associated with adverse outcome after acute myocardial infarction in the coronary intervention era. Am Heart J 2005; 150: 814–20.
• 4) Norhammar 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: 1827–31.
• 5) Hoebers LP, Damman P, Claessen BE, Vis MM, Baan J Jr, van Straalen JP, et al: Predictive value of plasma glucose level on admission for short and long term mortality in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Am J Cardiol 2012; 109: 53–59.
• 6) Ishihara M, Kagawa E, Inoue I, Kawagoe T, Shimatani Y, Kurisu S, et al: Impact of admission hyperglycemia and diabetes mellitus on short- and long-term mortality after acute myocardial infarction in the coronary intervention era. Am J Cardiol 2007; 99: 1674–79.
• 7) 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 diabetes. Circulation 2005; 111: 3078–86.
• 8) Borja Ibanez, Stefan James, Stefan Agewall, Manuel J. Antunes, Chiara Bucciarelli-Ducci, He´ctor Bueno, et al. The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018 Jan 7;39(2):119-77.
• 9) Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 1989; 2: 358-367.
• 10) Haffner SM, Lehto S, Ronnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in non-diabetic subjects with and without prior myocardial infarction. N Eng J Med 1998;339(4):229-43.
• 11) Ravipati G, Aronow WS, Ahn C, Sujata K, Saulle LN, Weiss MB. Association of hemoglobin A(1c) level with the severity of coronary artery disease in patients with diabetes mellitus. Am J Cardiol 2006;97(7):968-69.
• 12) Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycemia and increased risk of death after myocardial systemic infarction in patients with and without diabetes: an overview. Lancet 2000;355(9206):773-78.
• 13) Esposito K, Nappo F, Marfella R, Giugliano G, Giugliano F, Ciotola M, et al: Inflammatory cytokine concentrations are acutely increased by hyperglycemia in humans: role of oxidative stress. Circulation 2002; 106: 2067–72.
• 14) Marfella R, Siniscalchi M, Esposito K, Sellitto A, De Fanis U, Romano C, et al: Effects of stress hyperglycemia on acute myocardial infarction: role of inflammatory immune process in functional cardiac outcome. Diabetes Care 2003; 26: 3129–35.
• 15) Shechter M, Merz CN, Paul-Labrador MJ, Kaul S: Blood glucose and platelet-dependent thrombosis in patients with coronary artery disease. J Am Coll Cardiol 2000; 35: 300–7.
• 16) Eberli FR, Weinberg EO, Grice WN, Horowitz GL, Apstein CS. Protective effect of increased glycolytic substrate against systolic and diastolic dysfunction and increased coronary resistance from prolonged global underperfusion and reperfusion in isolated rabbit hearts perfused with erythrocyte suspensions. Circ Res 1991; 68: 466–81.
• 17) Shah B, Amoroso NS, Sedlis SP: Hyperglycemia in nondiabetic patients presenting with acute myocardial infarction. Am J Med Sci 2012; 343: 321–26.
• 18) OliverMF, Opie LH. Effects of glucose and fatty acids on myocardial ischaemia and arrythmias. Lancet 1994;343(8890):155-158.
• 19) Jensen CJ, Eberle HC, Nassenstein K, Schlosser T, Farazandeh M, Naber CK, et al. Impact of hyperglycaemia at admission in patients with acute ST-segment elevation myocardial infarction as assessed by contrast-enhanced MRI. Clin Res Cardiol 2011;100(8):649-659.
• 20) Eitel I, Hintze S, de Waha S, Fuernau G, Lurz P, Desch S, et al. Prognostic impact of hyperglycemia in non-diabetic and diabetic patients with ST-elevation myocardial infarction: insights from contrast-enhanced magnetic resonance imaging. Circ Cardiovasc Imaging 2012;5(6):708-718.
• 21) Hsu CW, Chen HH, Sheu WH, et al. Initial serum glucose level as a prognostic factor in the first acute myocardial infarction. Ann Emerg Med. 2007;49(5):618-26.
• 22) Takada JY, Ramos RB, Roza LC, Avakian SD, Ramires JAF, Mansur AP. In-hospital death in acute coronary syndrome was related to admission glucose in men but not in women. Cardiovasc Diabetol 2012;11:47.
• 23) Straumann E, Kurz DJ,Muntwyler J, Stettler I, Furrer M, Naegeli B, et al. Admission glucose concentrations independently predict early and late mortality in patients with acute myocardial infarction treated by primary or rescue percutaneous coronary intervention. Am Heart J 2005;150(5):1000-6.
• 24) Hoebers LP, Damman P, Claessen BE, Vis MM, Baan J Jr, van Straalen JP, et al. Predictive value of plasma glucose level on admission for short and long term mortality in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Am J Cardiol 2012;109(1):53-9.
• 25) Zhao CJ, Hao ZX, Liu R, Liu Y. Admission glucose and risk of early death in non-diabetic patients with ST-segment elevation myocardial infarction: a meta-analysis. Med Sci Monit 2015 May 14;21:1387-94.