Abstract
BackgroundPatients with acute myocardial infarction (AMI) often accompanied by admission hyperglycemia, which usually predicts a poor clinical outcomes for non-diabetes mellitus. Appropriate cut-point to identify high risk individuals in these patients remains controversial.MethodsOne thousand six hundred ninety-eight non-diabetes AMI patients in this retrospective study were divided into 3 groups according to admission glucose levels (euglycemia group≤140 mg/dL, moderate hyperglycemia group 141–179 mg/dL, severe hyperglycemia group≥180 mg/dL). The primary endpoint of this study was all-cause in-hospital mortality rate. In-hospital motality related risk factors was analyzed by multivariate binary logistic regression analyses.ResultsAll myocardial necrosis markers and Log NT-proBNP in severe hyperglycemia group were significantly higher than those in the other 2 groups. Logistic regression showed that independent predictors of the in-hospital mortality rate in non-diabetic patients with AMI were age (OR = 1.057, 95% CI 1.024–1.091, P < 0.001), logarithm of the N-terminal pro-brain natriuretic peptide (OR = 7.697, 95% CI 3.810–15.550, P < 0.001), insufficient myocardial reperfusion (OR = 7.654, 95% CI 2.109–27.779, P < 0.001), percutaneous coronary intervention (OR = 0.221, 95% CI 0.108–0.452, P < 0.001) and admission glucose (as categorical variable). Patients with moderate hyperglycemia (OR = 1.186, 95% CI 0.585–2.408, P = .636) and severe hyperglycemia (OR = 4.595, 95% CI 1.942–10.873, P = 0.001) had a higher all-cause in-hospital mortality rate compared with those with euglycemia after AMI in non-diabetic patients.ConclusionsThe all-cause in-hospital mortality risk increases remarkably as admission glucose levels elevated in non-diabetic patients with AMI, especially in patients with admission glucose levels ≥180 mg/dL. Severe admission hyperglycemia could be regarded as prospective high-risk marker for non-diabetic AMI patients.
Highlights
Patients with acute myocardial infarction (AMI) often accompanied by admission hyperglycemia, which usually predicts a poor clinical outcomes for non-diabetes mellitus
The risks of cardiovascular events are higher in patients with acute myocardial infarction (AMI) who have not been diagnosed with diabetes mellitus (DM) or whose DM is diagnosed only after admission than in patients with AMI and normal blood glucose levels
creatine kinase-MB (CK-MB)(P < 0.001), cardiac troponin I(P < 0.001), MYO(P < 0.001) Log NT-proBNP was significantly higher in severe hyperglycemia group than in the other 2 groups, which corresponded to a lower ejection fraction
Summary
Patients with acute myocardial infarction (AMI) often accompanied by admission hyperglycemia, which usually predicts a poor clinical outcomes for non-diabetes mellitus. The risks of cardiovascular events are higher in patients with acute myocardial infarction (AMI) who have not been diagnosed with diabetes mellitus (DM) or whose DM is diagnosed only after admission than in patients with AMI and normal blood glucose levels. Previous studies have analyzed the effect of insulin treatment for controlling admission blood glucose levels for a reduction in recent adverse events in patients with AMI [6]. There is no clear conclusion on which level of blood glucose control can benefit non-diabetic patients. In this retrospective study, we compared baseline data and the incidence of adverse events during hospitalization in nondiabetic patients with AMI with different admission blood glucose levels to determine possible influential factors
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