Association of stress hyperglycemia and atrial fibrillation in myocardial infarction

Abstract

Stress hyperglycemia has an untoward effect on prognosis in acute myocardial infarction (AMI). Evidence on the interrelationship between stress hyperglycemia and atrial fibrillation (AF) in AMI is sparse. We hypothesized that stress hyperglycemia and AF, both being markers of worse in-hospital prognosis, may be interrelated and we therefore analyzed the relationship between stress hyperglycemia and AF in AMI. The study was a retrospective analysis of 543 patients with AMI. The average age was 63.8 +/- 10.6 years and 54.9% were male. AF was more prevalent in 200 AMI patients with admission glucose >or= 8.0 mmol/l (15.00%) than in 343 patients with admission glucose < 8 mmol/l (7.87%), Pearson's chi-squared P = 0.010, OR 2.07 (95% CI 1.180-3.637). In AMI patients with neither stress hyperglycemia nor AF, in-hospital mortality was 1.67%; in patients with stress hyperglycemia without AF, the mortality was 3.85%. In patients with AF without stress hyperglycemia, mortality was high at 13.04%, and in patients with both stress hyperglycemia and AF it was extremely high at 24.14%. Hyperglycemia (r = 0.1680, P = 0.0472) but not AF correlated with the size of the AMI. Compared with an AF prevalence of 8.28% in the normoglycemic group, AF was found more often (14.65%) in a group with diabetes mellitus (DM), Pearson's chi-squared P = 0.02, OR = 2.04 (95% CI 1.06-3.93). There was no significant difference in the occurrence of AF between patients with previously diagnosed DM and those with new-onset DM (Fisher's exact test P = 0.34). Stress hyperglycemia is associated with increased prevalence of AF in AMI. Patients with both stress hyperglycemia at admission (>or= 8.0 mmol/l) and AF had almost 14.5 times higher in-hospital mortality than patients who had neither stress hyperglycemia nor AF. Stress hyperglycemia was an independent predictor of the in-hospital mortality in multivariate regression analysis, but AF was not.