0432: Impact of admission hyperglycemia on one-year mortality in non-diabetic patients admitted for rescue PCI: Data from the “Observatoire des infarctus de Côte d’Or”

Abstract

Rescue percutaneous coronary intervention (PCI) is associated with improved clinical outcomes for ST-segment myocardial infarction (STEMI) patients after failed fibrinolysis therapy. Hyperglycemia on admission has been shown to be a powerful predictor of mortality after acute myocardial infarction, particularly in non-diabetic patients. The aim of our study was to assess the predictive value of admission glucose levels on long-term mortality in patients with rescue PCI. From the “Observatoire des infarctus de Côte d’Or” (RICO) survey, 510 consecutive non-diabetic STEMI patients admitted to the intensive care unit for rescue PCI after failed fibrinolysis therapy were included in the study. We analyzed one-year cardiovascular mortality in these patients. Rescue PCI was deemed necessary in patients with ST-segment resolution <50% 90 minutes after lysis, or a thrombolysis in myocardial infarction (TIMI) perfusion grade in the infarct-related artery <3 at the time of angiography in patients with persisting equivocal symptoms. Patients were classified according to admission glycemia: <11 mmol/L (group I, n=452) and =11 mmol/L (group II, n=58). One-year cardiovascular (CV) mortality was 6% in group I and 29% in group II (p<0.001). Patients with hyperglycemia on admission were more likely to develop cardiogenic shock (43% vs. 10%, p<0.001) and to have higher peak CPK (4052(2465-6283) vs. 2667 (1303-4865), p=0.007), reflecting a bigger infarct size than the others, although the revascularization results were similar. By multivariate analysis, glycemia on admission =11 mmol/L (odds ratio 6.380, 95% confidence interval 2.075 to 19.617, p=0.001) and GRACE risk score (OR: 1.027, 95% CI 1.012-1.042, p<0,001) were independently associated with 1-year CV mortality. In non-diabetic patients undergoing rescue PCI after failed fibrinolysis, glycemia on admission is a predictive factor for long-term CV survival. This study suggests that evaluating early glycemic control may be useful in the setting of rescue PCI.