Abstract
BackgroundHyperglycemia is associated with increased morbidity and mortality in patients with an acute myocardial infarction (AMI). We evaluated whether complications after AMI are associated with absolute or relative glycemia.MethodsA total of 192 patients with AMI were randomized to intensive or conventional insulin therapy. Absolute glycemia was defined as mean blood glucose level (BGL) during the first 24 h following randomization. Relative glycemia was defined by the stress hyperglycaemia ratio (SHR), calculated as mean BGL divided by average glucose concentration over the prior 3 months estimated from glycosylated haemoglobin. The primary endpoint was a “complicated AMI”, defined as an AMI complicated by death, congestive cardiac failure, arrhythmia, cardiac arrest, reinfarction, cardiogenic shock, inotrope use or emergency revascularization.ResultsThere was not a significant association between mean BGL and complicated AMI (odds ratio (OR) 1.05 per mmol/L glucose increment, 95% confidence intervals (CI) 0.93–1.19). In contrast, SHR was positively associated with a complicated myocardial infarction (OR 1.22 per 0.1 SHR increment, 95% CI 1.06–1.42), and individual complications of death (OR 1.55, 95% CI 1.14–2.11), congestive cardiac failure (OR 1.27, 95% CI 1.05–1.54), arrhythmia (OR 1.31, 95% CI 1.12–1.54) and cardiogenic shock (OR 1.42, 95% CI 1.03–1.97). The relationship between SHR and a complicated AMI was independent of diabetic status, intensive insulin therapy, sex and hypoglycemia.ConclusionsRelative, but not absolute, glycemia during insulin treatment is independently associated with complications after an AMI. Future studies should investigate whether basing therapeutic glycaemic targets on relative glycemia improves patient outcomes.
Highlights
Hyperglycemia is associated with increased morbidity and mortality in patients with an acute myocardial infarction (AMI)
82 patients were defined as having a complicated AMI: 6 patients died, 22 developed congestive cardiac failure, 48 had an arrhythmia, 21 had a cardiac arrest, 3 had a re-infarction, 5 developed cardiogenic shock, 10 were treated with inotropic support, 26 required a rescue percutaneous transluminal coronary angioplasty (PTCA) and 7 an emergency coronary arterial bypass graft (CABG)
Subjects with a complicated AMI were more likely to be female, there were no significant differences in age, Charlson Comorbidity Index, intensive insulin therapy, known diabetes, other cardiovascular risk factors, cardiovascular medications, serum cholesterol, peak creatinine phosphokinase and use of anticoagulant, thrombolytic and angioplasty treatment and ST elevation on ECG between patients with a complicated and uncomplicated AMI (Table 1)
Summary
Hyperglycemia is associated with increased morbidity and mortality in patients with an acute myocardial infarction (AMI). Several other studies have reported that relative glycemia at hospital admission predicts outcomes for patients admitted to hospital with a stroke [9], acute illness [10], acutely ill requiring intensive care unit (ICU) admission [11] and after percutaneous coronary intervention [12]. These studies demonstrate that quantifying relative hyperglycemia at admission to hospital provides important prognostic information in patients with and without diabetes
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