Abstract 337: Impact of High Glucose Level at Admission on Thirty Days Clinical Outcomes for the Out-of-Hospital Cardiac Arrest Patients With Acute Coronary Event Undergoing Coronary Intervention With Hypothermia Therapy

Abstract

Background: The aim of this study was to evaluate the effect of hyperglycemia at admission on the 30-days clinical outcomes of the patients (pts) with cardiac arrest due to acute coronary event (ACE) undergoing PCI with mild therapeutic hypothermia (MHT). Methods: Data over a five-year period (2005-2009) were obtained for 452 patients treated with MHT from a multicenter registry in Japan. Of these patients, all of 185 pts were diagnosed with ACE by emergency angiography immediately after recovery of spontaneous circulation (ROSC), and were subsequently treated with MHT and PCI. These patients were divided into groups based on the blood glucose (BS) at admission by receiver operating characteristics; Group A: BS at admission >=306mg/dl and Group B: BS at admission <306mg/dl. Cerebral performance category (CPC) with levels 1 (Normal mental performance), 2 (moderate disability), 3 (severe disability), 4 (vegetative state), 5 (death) was used at 30days. Poor neurologic outcome was defined in CPC 3, 4 and 5. Results: Patient demographics of Group A (n=67) were younger (mean age 57 vs. 63, p<0.0001), longer time from arrest to ROSC (35min. vs. 24 min., p=0.0004). The proportions of shockable rhythm and the time to achieve target temperature were not different. The rates of STEMI was more seen in Group A (76.1%) compared with Group B (63.6%); however, there was no significant differences (p=0.0781). There was no significantly different in mortality rate (25.4% vs. 17.8%, p=0.2202) between the two groups, however, neurologic outcome was significantly better in group B compared with group A (35.8% vs. 65.3%, p=0.0001). Logistic regression analysis revealed that the predictors of poor neurologic outcome were unshockable rhythm (Odds ratio [OR]: 3.82, p=0.0026), age over 70 (OR: 9.3, p<0.0001), time from collapse to ROSC (OR 1.04, p<0.0001), and BS at admission over 306mg/dl (OR: 3.8, p=0.0005). Conclusions: High glucose level at admission did not affect the mortality; however, had an impact on neurologic outcome for the patients with ROSC after cardiac arrest due to ACS undergoing PCI with MHT.