Admission glucose and in-hospital mortality in patients with acute myocardial infarction, with and without diabetes, from 2001 to 2011 (the China PEACE-Retrospective Acute Myocardial Infarction Study): a retrospective analysis

Abstract

BackgroundThe relation between blood glucose concentrations on hospital admission and in-hospital mortality in patients with acute myocardial infarction, with and without diabetes, has not been well characterised in Chinese patients. MethodsUsing the China PEACE-Retrospective Acute Myocardial Infarction Study, we took a representative sample of patients with acute myocardial infarction from 2001, 2006, and 2011 and classified them according to their blood glucose concentrations on admission to hospital (<3·9, 3·9–7·8, 7·8–11·1, ≥11·1 mmol/L). We compared in-hospital mortality across these admission glucose categories, stratified by diabetes status. The central ethics committee at the China National Center for Cardiovascular Diseases approved the study, with a waiver of patients' written consent. This study is registered with www.ClinicalTrials.gov, NCT01624883. FindingsDespite an increase in the proportion of patients with diabetes admitted to hospital for acute myocardial infarction in 2001–11 (17·5% in 2001, 20·1% in 2006, and 23·1% in 2011; p=0·0001), in-hospital mortality associated with hyperglycaemia on admission did not change (p=0·2). The relation between blood glucose concentration on admission and in-hospital mortality risk in patients with acute myocardial infarction with or without recognised diabetes was consistent across different study years (p value for interaction 0·9). After adjustment for patients characteristics and clinical status, compared with euglycaemic patients (7·8–11·1 mmol/L), hyperglycaemia (≥11·1 mmol/L) was associated with an increase in mortality risk both in patients with known diabetes (odds ratio [OR] 2·49, 95% CI 1·59–3·90) and in patients without known diabetes (2·59, 2·17–3·09). By contrast, hypoglycaemia (<3·9 mmol/L) was associated with a greater risk of in-hospital mortality only in patients with known diabetes (2·93, 1·16–7·39). A U-shaped relation exists between blood glucose concentrations on admission and in-hospital mortality in patients with diabetes, but a more linear relationship exists in patients without diabetes. InterpretationIn Chinese patients with acute myocardial infarction, both hyperglycaemia and hypoglycaemia on admission to hospital are associated with an increased risk for in-hospital mortality in patients with diabetes. However, only hyperglycaemia, but not hypoglycaemia, is a predictor of increased mortality for patients without diabetes. FundingThis project was partly supported by the Research Special Fund for Public Welfare Industry of Health (201202025) from the National Health and Family Planning Commission of China, the National Key Technology R&D Program (2013BAI09B01) from the Ministry of Science and Technology of China, and grant 20131100501 from State Administration of Foreign Experts Affairs of China. HMK is supported by grant U01 HL105270-05 (Center for Cardiovascular Outcomes Research at Yale University) from the US National Heart, Lung, and Blood Institute. The sponsors had no role in the conduct of the study; the collection, management, analysis, and interpretation of the data; or the preparation or approval of the abstract.