024 Acute hyperglycemia is associated with adverse outcome after primary angioplasty for acute myocardial infarction: GLAMI Study

Abstract

Hyperglycemia has been shown to be a powerful predictor of worse outcome after ST segment-elevation myocardial infarction (STEMI). The aim of this study was to investigate the relation between acute hyperglycemia (AHG) and in-hospital outcome after primary angioplasty for STEMI. We prospectively included 250 patients who underwent revascularization with primary angioplasty for STEMI, 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. Among the 250 patients with STEMI included in the study, 124 (49.6%) patients had acute hyperglycemia. There was no difference among the two groups with regard to clinical characteristics except for the presence of diabetes (58%vs 7.1%, p<0.001), hypertension (21.4% vs 38.7%, p=0.002) and hyperlipidemia (4.8% vs 14.5%, p=0.007. At admission, patients with AHG were more likely to have tachycardia (26.6% vs 14.3%, p=0.012) and to present heart failure (24.2% vs 12.7%, p=0.01). The admission TIMI flow was similar in the two groups. TIMI 3 flow postprocedure was more common in patients without AHG (89.7% vs 75%, p=0.002). The in-hospital mortality rate was significantly higher in patients with AHG than in patients without (22.6% vs 4.8%, p <0.001). In multivariate analysis, independently of other determinants of death (age, risk factors, location of STEMI, infarct size, incomplete resolution of ST-segment and angiographic success), acute hyperglycemia was a predictor of in-hospital mortality (OR: 3.14; 95% IC, 1.5-6.5; p=0.0001). Acute hyperglycemia in patients with STEMI was an important predictor of mortality, this suggest the usefulness of evaluating early glycemic control in the setting of reperfusion for acute myocardial infarction.