Relationship between fasting glucose levels and in-hospital mortality in Chinese patients with acute myocardial infarction and diabetes mellitus: a retrospective cohort study.

Hao Liang,Min Li,Li Ming Chen,Shi Liang Jiang,Yi Chen Guo,Xu Zhang,Wei Zhong Han

doi:10.1186/s12872-016-0331-2

Hao Liang, Min Li + Show 5 more

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https://doi.org/10.1186/s12872-016-0331-2

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Abstract

BackgroundPrevious studies have demonstrated that elevated admission and fasting glucose (FG) is associated with worse outcomes in patients with acute myocardial infarction (AMI). However, the quantitative relationship between FG levels and in-hospital mortality in patients with AMI remains unknown. The aim of the study is to assess the prevalence of elevated FG levels in hospitalized Chinese patients with AMI and diabetes mellitus and to determine the quantitative relationship between FG levels and the in-hospital mortality as well as the optimal level of FG in patients with AMI and diabetes mellitus.MethodsA retrospective study was carried out in 1856 consecutive patients admitted for AMI and diabetes mellitus from 2002 to 2013. Clinical variables of baseline characteristics, in-hospital management and in-hospital adverse outcomes were recorded and compared among patients with different FG levels.ResultsAmong all patients recruited, 993 patients (53.5 %) were found to have FG ≥100 mg/dL who exhibited a higher in-hospital mortality than those with FG < 100 mg/dL (P < 0.001). Although there was a high correlation between FG levels and in-hospital mortality in all patients (r = 0.830, P < 0.001), the relationship showed a J-curve configuration with an elevated mortality when FG was less than 80 mg/dL. Using multivariate logistic regression models, we identified that age, FG levels and Killip class of cardiac function were independent predictors of in-hospital mortality in AMI patients with diabetes mellitus.ConclusionsMore than half of patients with AMI and diabetes mellitus have FG ≥100 mg/dL and the relationship between in-hospital mortality and FG level was a J-curve configuration. Both FG ≥ 100 mg/dL and FG <80 mg/dL were identified to be independent predictors of in-hospital mortality and thus the optimal FG level in AMI patients with diabetes mellitus appears to be 80–100 mg/dL.

Highlights

Previous studies have demonstrated that elevated admission and fasting glucose (FG) is associated with worse outcomes in patients with acute myocardial infarction (AMI)
Recent studies have shown that an elevated admission or fasting glucose (FG) level is common in patients with acute myocardial infarction (AMI) and is associated with an increased short-term mortality and a high incidence of congestive heart failure [1,2,3,4,5]
Hyperglycemia associated with AMI portends a gloomy short-term outcome in these patients, whether a low level of glucose would be a good omen for these subjects is unknown

Summary

Introduction

Previous studies have demonstrated that elevated admission and fasting glucose (FG) is associated with worse outcomes in patients with acute myocardial infarction (AMI). Among many clinical variables affecting short-term outcomes in patients with AMI, an elevated FG level, termed as stress hyperglycemia, has been identified as a new independent predictor of 30-day mortality in a group of patients with AMI and hyperglycemia [5]. This finding has important clinical significance because FG levels may serve as a simple marker to help clinicians stratify risk for optimal triage and management. The present study was carried out to assess the prevalence of elevated FG levels in hospitalized Chinese patients with AMI and diabetes mellitus and to determine the quantitative relationship between FG levels and the in-hospital mortality as well as the optimal level of FG in AMI patients with diabetes mellitus

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