Non-diabetic Acute Myocardial Infarction Patients Research Articles

A Systematic Review and Meta-analysis of the Effect of Apomorphine in Patients with Parkinson’s Disease

Abstract Introduction: Regarding a potential relationship between diabetes and the prognostic significance of hyperglycaemia in patients presenting with acute myocardial infarction (AMI), there is still debate. Therefore, we aimed in this study to demonstrate the effect of hyperglycaemia on different outcomes in AMI patients whether they are diabetic or not. Methods: Using the following search strategy: ‘Diabetes’ or ‘Diabetic’ AND ‘Acute myocardial infarction’ OR ‘AMI’ AND ‘hyperglycemia’ OR ‘glucose level’, we searched PubMed, Web of Science and Scopus for eligible articles that should undergo the screening process to determine its ability to be included in our study. Using Review Manager version 5.4 software, we conducted the meta-analysis of the included studies by pooling the mean difference (MD) in continuous variables, number and total of dichotomous variables to measure the odds ratio (OR) and generic inverse variance of OR or hazard ratio (HR) as they were reported in the included studies. Results: The difference between diabetes and non-diabetes patients regarding blood glucose level was found to be statistically significant with standardised MD of 1.39 (95% confidence interval [CI]: 1.12, 1.66, P < 0.00001). Hyperglycaemia in diabetic patients was statistically significantly associated with mortality with HR of 1.92 (95% CI: 1.45, 2.55, P < 0.00001) and OR of 1.76 (95% CI: 1.15, 2.7, P = 0.01). In non-diabetic patients admitted with AMI, hyperglycaemia was statistically significantly associated with mortality with HR of 1.56 (95% CI: 1.31, 1.86, P < 0.00001) and OR of 2.89 (95% CI: 2.47, 3.39, P < 0.00001). Moreover, hyperglycaemia in diabetic patients admitted with AMI was statistically significantly associated with occurrence of MACE with HR of 1.9 (95% CI: 1.19, 3.03, P = 0.007) and hyperglycaemia in non-diabetic AMI patients was statistically significantly associated with occurrence of MACE with HR of 1.6 (95% CI: 1.15, 2.23, P = 0.006). Conclusion: Hyperglycaemia in AMI patients is a predictor of worse outcomes including MACE and mortality whether these patients are diabetic or not. Some factors act as predictors for mortality in these patients including older age, higher glucose levels on admission and high Killip class.

CLINICAL RELEVANCE OF HIGH SENSITIVITY C-REACTIVE PROTEIN IN ACUTE MYOCARDIAL INFARCTION PATIENTS

Objectives: Poor cardiovascular outcomes have been linked to high-sensitivity C-reaction protein (hs-CRP), a biomarker of residual inflammatory risk. Whether or not a patient has diabetes mellitus, evaluate the relationship among hs-CRP levels estimated at hospital admission and in-hospital consequences and death. Methods: This prospective cohort study included 100 acute myocardial infarction (AMI) patients with both non-ST elevation myocardial infarction (STEMI) and STEMI who were admitted to the cardiac care critical care unit intensive therapy unit. Results: Diabetics had a considerably higher incidence of hypertension (p=0.001) and dyslipidemia (p=0.001) compared to non-diabetics. Diabetics exhibited a significantly higher mean hs-CRP level (6.76±1.12 vs. 3.65±0.98 mg/dL; p=0.01) than non-diabetics. Meanwhile, compared to non-diabetics, diabetics utilized significantly more aspirin (p=0.001), beta-blockers (p=0.001), angiotensin receptor blockers (ARBs) (p=0.01), and statins (p=0.001). Furthermore, compared to those with hs-CRP <3 mg/L, those with hs-CRP ≥3 mg/dL had a significantly higher incidence of dyslipidemia (p=0.001) and hypertension (p=0.001). Conclusion: The results of the current study demonstrated that hs-CRP upon admission is a valid predictor of hospital morbidity and death in patients with AMI who are diabetic or non-diabetic. Individuals with diabetes showed greater CRP levels than non-diabetic AMI patients did.

Comparison of serum ferritin levels between diabetic and non-diabetic acute myocardial infarction patients

Comparison of serum ferritin levels between diabetic and non-diabetic acute myocardial infarction patients

The Prognostic Value of the Triglyceride-Glucose Index in Forecasting Ten-Year Major Adverse Cardiovascular Events in Non-Diabetic Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention.

This study aimed to explore the association between the triglyceride-glucose (TyG) index and major adverse cardiovascular events (MACE) over a ten-year period in non-diabetic patients with acute myocardial infarction (MI) undergoing primary percutaneous coronary intervention (PCI). We included 375 consecutive non-diabetic patients presenting with acute MI who underwent primary PCI. The TyG index was calculated and patients were divided based on a cut-off value of ≥ 8.84 into high and low TyG index groups. The incidence of MACE, including all-cause mortality, target vessel revascularization, reinfarction, and rehospitalization for heart failure, was assessed over 10 years. Over the next 10 years, patients who underwent PCI for acute MI experienced a significantly higher incidence of MACE in the group with a high TyG index (≥ 8.84) (P = 0.004). Multivariable analysis revealed that the TyG index independently predicted MACE in these patients [odds ratio = 1.64; 95% confidence interval (CI): 1.22-2.21; P = 0.002]. Analysis of the receiver operating characteristic curve indicated that the TyG index effectively predicted MACE in patients with acute MI following PCI, with an area under the curve of 0.562 (95% CI: 0.503-0.621; P = 0.038). This study established a correlation between high TyG index levels and an elevated risk of MACE in non-diabetic patients with acute MI. The findings suggest that the TyG index could be a reliable indicator of clinical outcomes for non-diabetic acute MI patients undergoing PCI.

Evaluation of Lipid Parameters in Diabetic and Non-Diabetic Acute Myocardial Infarction Patients in Al-Bayda

Evaluation of Lipid Parameters in Diabetic and Non-Diabetic Acute Myocardial Infarction Patients in Al-Bayda

Optimal glucose, HbA1c, glucose-HbA1c ratio and stress-hyperglycaemia ratio cut-off values for predicting 1-year mortality in diabetic and non-diabetic acute myocardial infarction patients

BackgroundStress-induced hyperglycaemia at time of hospital admission has been linked to worse prognosis following acute myocardial infarction (AMI). In addition to glucose, other glucose-related indices, such as HbA1c, glucose-HbA1c ratio (GHR), and stress-hyperglycaemia ratio (SHR) are potential predictors of clinical outcomes following AMI. However, the optimal blood glucose, HbA1c, GHR, and SHR cut-off values for predicting adverse outcomes post-AMI are unknown. As such, we determined the optimal blood glucose, HbA1c, GHR, and SHR cut-off values for predicting 1-year all cause mortality in diabetic and non-diabetic ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients.MethodsWe undertook a national, registry-based study of patients with AMI from January 2008 to December 2015. We determined the optimal blood glucose, HbA1c, GHR, and SHR cut-off values using the Youden’s formula for 1-year all-cause mortality. We subsequently analyzed the sensitivity, specificity, positive and negative predictive values of the cut-off values in the diabetic and non-diabetic subgroups, stratified by the type of AMI.ResultsThere were 5841 STEMI and 4105 NSTEMI in the study. In STEMI patients, glucose, GHR, and SHR were independent predictors of 1-year all-cause mortality [glucose: OR 2.19 (95% CI 1.74–2.76); GHR: OR 2.28 (95% CI 1.80–2.89); SHR: OR 2.20 (95% CI 1.73–2.79)]. However, in NSTEMI patients, glucose and HbA1c were independently associated with 1-year all-cause mortality [glucose: OR 1.38 (95% CI 1.01–1.90); HbA1c: OR 2.11 (95% CI 1.15–3.88)]. In diabetic STEMI patients, SHR performed the best in terms of area-under-the-curve (AUC) analysis (glucose: AUC 63.3%, 95% CI 59.5–67.2; GHR 68.8% 95% CI 64.8–72.8; SHR: AUC 69.3%, 95% CI 65.4–73.2). However, in non-diabetic STEMI patients, glucose, GHR, and SHR performed equally well (glucose: AUC 72.0%, 95% CI 67.7–76.3; GHR 71.9% 95% CI 67.7–76.2; SHR: AUC 71.7%, 95% CI 67.4–76.0). In NSTEMI patients, glucose performed better than HbA1c for both diabetic and non-diabetic patients in AUC analysis (For diabetic, glucose: AUC 52.8%, 95% CI 48.1–57.6; HbA1c: AUC 42.5%, 95% CI 37.6–47. For non-diabetic, glucose: AUC 62.0%, 95% CI 54.1–70.0; HbA1c: AUC 51.1%, 95% CI 43.3–58.9). The optimal cut-off values for glucose, GHR, and SHR in STEMI patients were 15.0 mmol/L, 2.11, and 1.68 for diabetic and 10.6 mmol/L, 1.72, and 1.51 for non-diabetic patients respectively. For NSTEMI patients, the optimal glucose values were 10.7 mmol/L for diabetic and 8.1 mmol/L for non-diabetic patients.ConclusionsSHR was the most consistent independent predictor of 1-year all-cause mortality in both diabetic and non-diabetic STEMI, whereas glucose was the best predictor in NSTEMI patients.

Association between Admission Hyperglycemia and Culprit Lesion Characteristics in Nondiabetic Patients with Acute Myocardial Infarction: An Intravascular Optical Coherence Tomography Study.

Background Hyperglycemia is frequently observed in acute myocardial infarction (AMI). Diabetes mellitus (DM) patients and non-DM patients have different culprit lesion phenotypes and few data are available on non-DM patients with admission hyperglycemia. Therefore, we aimed to investigate the association between admission hyperglycemia and culprit lesion characteristics using optical coherence tomography (OCT) in AMI patients. Methods and Results We consecutively enrolled 434 patients with AMI, and 277 patients were included in analysis: 65.7% (n = 182) non-DM patients and 34.3% (n = 95) DM patients. We measured acute blood glucose (ABG) and hemoglobin A1c to calculate the acute-to-chronic glycemic ratio (A/C). Then, we grouped non-DM patients into tertiles of A/C. OCT-based culprit lesion characteristics were compared across A/C tertiles in non-DM patients and between DM and non-DM patients. Non-DM patients had fewer lipid-rich plaques (52.7% versus 68.4%, p = 0.012) and thin-cap fibroatheroma (TCFA) (19.8% versus 34.7%, p = 0.006) than DM patients but similar prevalence of plaque rupture (47.3% versus 56.8%, p = 0.130). Non-DM patients with the highest A/C tertile had the highest prevalence of plaque rupture (pfor trend = 0.002), lipid-rich plaque (pfor trend = 0.001), and TCFA (pfor trend = 0.003). A/C > 1.22 but not ABG > 140 mg/dl predicted a high prevalence of plaque rupture, lipid-rich plaque, and TCFA in non-DM patients. Conclusions In AMI patients without DM, admission hyperglycemia is associated with vulnerable culprit lesion characteristics, and A/C is a better predictor for vulnerable culprit plaque characteristics than ABG. These results call for a tailored evaluation and management of glucose metabolism in nondiabetic AMI patients. This trial is registered with NCT03593928.

High admission glucose levels predict worse short-term clinical outcome in non-diabetic patients with acute myocardial infraction: a retrospective observational study

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.

Glycemic variability is associated with myocardial damage in nondiabetic patients with ST-elevation myocardial infarction.

BackgroundGlycemic variability (GV) induces coronary microcirculatory disturbance and myocardial damage in diabetic patients with acute myocardial infarction. However, in nondiabetic acute myocardial infarction patients, the relationship between GV and myocardial damage remains unclear. Patients and methodsWe investigated GV with a continuous glucose monitoring system in nondiabetic ST-segment elevation myocardial infarction patients treated with emergent percutaneous coronary intervention. GV was expressed as the mean amplitude of glycemic excursions (MAGE). Myocardial damage was estimated by myocardial blush grade and ST-segment resolution (STRes). STRes was defined as complete (>70%), partial (30–70%), or none (<30%). ResultsConsecutive patients (n=73) were enrolled and classified into a lower or higher MAGE group on the basis of the median MAGE. The higher MAGE group showed lower levels of myocardial blush grade (2.41±0.76 vs. 1.72±0.85, P=0.001) and STRes (complete: 56.8 vs. 33.3%, P=0.044; partial: 32.4 vs. 36.1%, P=0.741; none: 10.8 vs. 30.6%, P=0.037). ConclusionGV was associated with myocardial damage after percutaneous coronary intervention in nondiabetic ST-segment elevation myocardial infarction patients.

Clinical impact of admission hyperglycemia on in-hospital mortality in acute myocardial infarction patients

BackgroundAcute hyperglycemia on admission is common in acute myocardial infarction (AMI) patients regardless of diabetic status, and is known as one of prognostic factors. However, the effect of hyperglycemia on non-diabetic patients is still on debate. MethodsA total of 12,625 AMI patients (64.0±12.6years, 26.1% female) who were enrolled in Korea Acute Myocardial Infarction Registry-National Institute of Health between November 2011 and December 2015, were classified into 4367 diabetes (65.4±11.6years, 30.4% female) and 8228 non-diabetes (63.3±13years, 23.9% female). Patients were analyzed for in-hospital clinical outcome according to admission hyperglycemic status. ResultsIn diabetic patients, independent predictors of in-hospital mortality were old age, high HbA1C, pre-Thrombolysis In Myocardial Infarction (TIMI) flow 0, left ventricle ejection fraction<40%, cardiogenic shock and ventricular tachycardia. In non-diabetic patients, independent predictors of in-hospital mortality were old age, high admission glucose (≥200mg/dL), pre TIMI flow 0, failed percutaneous coronary intervention, low left ventricle ejection fraction<40%, cardiogenic shock, stent thrombosis and decreased Hb≥5g/dL. In hospital mortality was significantly higher in diabetic patients compared to non-diabetic patients (5.0% vs. 3.4%, p<0.001). However, non-diabetic patients with hyperglycemia have significantly higher mortality compared to diabetic patients (17.4% vs. 7.2%, p<0.001). Comorbidity including cardiogenic shock (p<0.001), cerebral hemorrhage (p=0.012), decreased Hb≥5g/dL (p=0.013), atrioventricular block (p<0.001) and ventricular tachycardia (p=0.007) was higher in non-diabetic with hyperglycemia than in diabetic patients. ConclusionsThese findings underscore clinical significance of admission hyperglycemia on in-hospital mortality in non-diabetic AMI patients.

Prognostic Value of Acute Hyperglycaemia in Non-Diabetic Acute Myocardial Infarction Patients

Introduction In recent years, much attention has been given to the evidence that the concomitant occurrence of hyperglycaemia in patients admitted to intensive care units with an acute myocardial infarction (AMI) enhances the risk of mortality and morbidity, whether the patient was diagnosed with having diabetes or not .1 In some cases, the elevation of glucose levels could simply be a marker of preexisting, but not yet detected, type 2 diabetes or impaired glucose tolerance (IGT). 2 This may mean that besides being causal, elevated glucose also could be a marker of existing insulin resistance and/or beta-cell failure that may contribute to the poor prognosis through other mechanisms. However, a positive association between hyperglycaemia at the time of the event and subsequent mortality from AMI has frequently been reported .3,4,5,6 A strong correlation between glycaemia and shock or development of heart failure has also been reported. 7 Consequently, understanding the possible mechanisms through which hyperglycaemia worsens the prognosis of AMI, as well the effectiveness of its control during AMI, seems to be of great relevance. It is now accepted worldwide that the most important factor influencing atherosclerotic plaque instability is inflammation. Elevated blood glucose levels per se adversely affect outcome through the cumulative effects of several mechanisms, including induction of endothelial dysfunction, oxidative stress, hyper coagulability and impaired fibrinolysis. 7,8 Acute hyperglycaemia in healthy subjects and in patients with impaired glucose tolerance or overt diabetes produces a rise in inflammatory markers. Following this line of thought, it might be speculated that the detrimental effect of stress hyperglycaemia in acute MI might also stem from its ability to increase inflammation. This study aims at exploring the association between the admission glycemic status and 30-day mortality in acute myocardial infarction in non diabetic patients.

Proposal of a New Approach to Study and Categorize Stress Hyperglycemia in Acute Myocardial Infarction

BackgroundStress hyperglycemia (SH) is a valid prognosticator of in-hospital complications and mortality in the intensive care unit, and is universally available, simple, and cost-effective. Even small refinements of SH can improve the risk stratification of patients with one of the most important diseases today—acute myocardial infarction (AMI). ObjectiveThe aim of the review was to analyze whether SH nomenclature and methodology have been consistent in the medical literature in order to identify possible methodological faults and to suggest possible solutions. DiscussionSH nomenclature and glycemic targets have been relatively uniform in recent years, but there has been a pronounced variability in the methodology. Recent meta-analysis showed that AMI patients with new hyperglycemia had a 3.6-fold increased risk of mortality during hospitalization in comparison to those who were normoglycemic. Four SH methodological mistakes were identified. First, using one cutoff value for SH instead of two different values (one for patients with diabetes mellitus [DM] and one for patients without DM). Second, analyzing, for example, either tertiles or quintiles without dividing AMI patients into subgroups according to their DM status. Third, studying only two subgroups (with SH and without SH), without determining the presence of DM, when DM is not analyzed. Fourth, failure to measure glycated hemoglobin. ConclusionsThe same admission blood glucose (BG) is a marker of different mortality risks in diabetic compared to nondiabetic AMI patients. For example, when admission BG is 108–126 mg/dL (6–7 mmol/L), then the risk of in-hospital mortality is higher in DM patients; however, with an admission BG of 162–180 mg/dL (9–10 mmol/L), the risk is lower in diabetic patients. We can improve the clinical utility of the admission BG in AMI if we analyze four groups of patients (those with and without previously diagnosed DM, and above and below the admission glycemia cutoff values for in-hospital mortality). Those cutoffs should be calculated separately for diabetic and nondiabetic AMI patients.

Comparative analysis of biochemical parameters in diabetic and non-diabetic acute myocardial infarction patients

BackgroundDiabetes is a metabolic disorder characterized by enhanced production of free radicals hence oxidative stress. The aim of this study was to evaluate the activity of cardiac and antioxidant enzymes in diabetic and non-diabetic acute myocardial infarction (AMI) patients. MethodsThis case–control study was conducted on 450 subjects (70–85 years). Subjects were divided into three groups (Normal, N; Non-diabetic AMI, N-AMI; and Diabetic AMI, D-AMI). Each individual was subjected to a detailed history, clinical examination, and cardiovascular parameters analysis (fasting blood sugar, HbA1c, systolic and diasystolic blood pressure, total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), TC/HDL and LDL/HDL ratios). Cardiac markers (Troponin-I, creatine phosphokinase (CPK), creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH), C-reactive protein (CRP) and aspartate aminotransferase (AST)) and oxidative stress markers (superoxide dismutase (SOD), malondialdehyde (MDA), glutathione (GSH), catalase (CAT)) were also assessed. All these parameters were compared between diabetic and non-diabetic AMI patients. ResultsD-AMI individuals had high level of TC, TG, LDL, and low level of HDL in comparison to N-AMI individuals. Study suggests that cardiac markers such as Troponin I, CPK, CK-MB, AST, LDH, and CRP levels were significantly increased in patients suffering from myocardial infarction with diabetes mellitus (DM) compared to patients of myocardial infarction without DM. The activity levels of antioxidant SOD and GSH were lower in D-AMI patients than in N-AMI. However, levels of MDA and CAT were higher in D-AMI than in N-AMI controls. ConclusionStudy suggests elevated cardiac markers and reduced antioxidants in D-AMI patients compared to N-AMI patients.

Clinical impact of acute hyperglycemia on development of diabetes mellitus in non-diabetic patients with acute myocardial infarction

BackgroundAcute hyperglycemia (AH) after the onset of acute myocardial infarction (AMI) is a manifestation of transient abnormal glucose metabolism that may reflect AMI severity, and thus be a predictor of poor prognosis. However, it remains unknown whether AH may predict development of de novo diabetes mellitus (dn-DM) in non-diabetic AMI patients. Methods and resultsAmong AMI patients registered in the Osaka Acute Coronary Insufficiency Study between 1998 and 2007, we investigated hospital records of 1493 patients who had an admission glycated hemoglobin A1c (HbA1c) level of ≤6.0% and were subjected to glycometabolic profiling after survival discharge. dn-DM was defined as initiation of diabetic medication or documentation of an HbA1c level of ≥6.5% during the 5-year follow-up period. AH, defined as an admission serum glucose level of ≥200mg/dl, was observed in 133 (8.9%) patients. dn-DM development was more frequent in post-AMI patients with AH than those without [24.8% vs 12.0%, adjusted hazard ratio (HR) 1.776, p=0.021], particularly among patients with an HbA1c of <5.6% on admission. Treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a reduced incidence of dn-DM in patients with AH (adjusted HR 0.397, p=0.031). ConclusionAdmission AH was a predictor of dn-DM in non-diabetic post-AMI patients. Renin–angiotensin system inhibitors were associated with reduced incidence of dn-DM in post-AMI patients with AH.

Abstract 18411: Dietary Intake of n-3 Long-Chain Polyunsaturated Fatty Acids, Diabetes Mellitus and Risk of Myocardial Infarction in Patients with Suspected Coronary Artery Disease

Background: A high intake of n-3 long-chain polyunsaturated fatty acids (LCPUFAs) is usually recommended in secondary prevention of coronary heart disease, particularly in patients with high triglyceride levels. Furthermore, a beneficial effect has been observed in patients with heart failure, who are frequently insulin resistant. Objective: The aim was to study the influence of impaired glucose metabolism and diabetes mellitus on the relation between dietary intake of n-3 LCPUFAs and risk of acute myocardial infarction (AMI) in patients undergoing coronary angiography for suspected coronary artery disease in 2000-2004. Design: This study included 2378 participants of the Western Norway B-Vitamin Intervention Trial (WENBIT). Daily intakes of n-3 LCPUFAs were estimated based on average dietary intakes during the last year as reported in a food-frequency questionnaire at baseline. Hazard ratios (HRs (95% CI)) of AMI (fatal and non-fatal) according to n-3 LCPUFA intake were calculated using Cox-regression adjusted for cardiovascular risk factors by comparing upper vs. lowest tertile and as trend across tertiles. Patients were followed until 31 December 2006. Results: Mean age of the participants was 62 years and 80% were male. Patients were sub-grouped into non-diabetics (HbA1c &lt;5.7%), pre-diabetics (HbA1c ≥5.7%), and diabetics (diagnosed), and were also stratified according to median triglyceride levels. Among patients with diabetes there was a significantly reduced risk of AMI in the upper vs. the lowest tertile of n-3 LCPUFA intake, multivariate HR (95% CIs) 0.34 (0.14, 0.82), P for trend=0.008. In non-diabetic patients with HbA1c &lt;5.7% there was an increased risk of AMI in the upper tertile of n-3 LCPUFA intake, 1.97 (1.05, 3.67), P for trend=0.02. Risk estimates were strengthened in their respective directions in both diabetic and non-diabetic patients with triglyceride levels above median. No risk associations were seen in pre-diabetics. Conclusions: Among patients with established coronary artery disease, a high intake of n-3 LCPUFAs was associated with a reduced risk of AMI in diabetic patients and an increased risk of AMI in non-diabetic patients. The effects were particularly pronounced in those with elevated triglyceride levels.

Abstract 202: Insulin Resistance as an Independent Predictor of Atherosclerosis Burden in Nondiabetic Patients with Acute Myocardial Infarction

Introduction: Experimental evidence suggests that insulin resistance (IR) is a major risk factor for accelerated atherosclerosis through indirect effects on systemic risk factors and direct effects on insulin signaling in vascular endothelium and plaque macrophages. Hypothesis: IR in persons without diabetes mellitus is associated with multi-vessel coronary artery disease (CAD) in acute myocardial infarction (AMI) patients. Methods: We examined 1111 non-diabetic AMI patients (HbA1c ≤ 6.5) enrolled in the multicenter TRIUMPH (years 2004-2008) registry. IR was estimated using the homeostasis model assessment of IR (HOMA-IR: fasting insulin (mU/l) x fasting blood glucose (mmol/l)]/22.5). The primary outcome was the extent of angiographic atherosclerosis (≤1-vessel vs. multi-vessel disease). Modified Poisson regression models were used to examine the association between IR and multi-vessel CAD. Results: Subjects were divided into quartiles based on HOMA-IR values (quartile 1: male &lt;=1.35, female &lt;=1.26; quartile 4: male &gt;4.00, female &gt;3.64). After adjusting for age, sex, hypertension, smoking, family history of CAD, LDL, HDL, and body mass index (BMI), IR was independently associated with multi-vessel CAD (Figure). As compared to the lowest quartile of IR, the highest quartile had more multi-vessel CAD [RR (95% CI)- 1.35 (1.11-1.64)]. Conclusion: In a large cohort of non-diabetic AMI patients, IR was associated with more advanced, multi-vessel CAD, independent of lipid levels and other components of the metabolic syndrome. This association is consistent with established experimental evidence and supports IR as a potential target for preventing atherosclerosis.

Abstract 31: Hyperglycemia During MI Hospitalization Predicts Subsequent Diabetes: Insights from the VA IHD-QUERI Cardiac Care Follow-Up Clinical Study (CCFCS)

Background: Among non-diabetic patients hospitalized with an acute myocardial infarction (AMI), in-hospital hyperglycemia is associated with adverse outcomes. This phenomenon may be due to undiagnosed diabetes (DM), which could have implications for in-hospital screening and post-discharge follow up. While high rates of newly-diagnosed DM have been reported in AMI patients, whether majority of these cases occur among those with in-hospital hyperglycemia is unknown. Methods: We examined a national cohort of AMI patients hospitalized in the VA between 10/2005 -7/2009, who did not have known DM, were not diagnosed with DM during hospitalization, and survived at least 6 months post-discharge. We assessed rates of inpatient hyperglycemia (defined as mean hospitalization glucose ≥140mg/dL) and DM diagnosis during 6 months after hospitalization (defined as ICD-9 diagnosis codes, prescription of any glucose-lowering medication, or HbA1c value ≥ 6.5%). Predictors of DM diagnosis were assessed using a multivariable logistic regression model. Results: Among 7875 non-diabetic AMI patients, 484 (6.1%) had inpatient hyperglycemia. Hyperglycemic patients were older, had greater AMI severity and burden of comorbidities, and were more likely to be treated with insulin during hospitalization. Six months following discharge, 100 (20.7%) hyperglycemic patients were diagnosed with DM, compared to 308 (4.2%) normoglycemic patients (p &lt;0.0001). After multivariable adjustment, in-hospital hyperglycemia remained a significant predictor of 6-month DM diagnosis (OR 5.15, 95% CI 3.97, 6.69). Other factors associated with DM diagnosis are listed in the Table. Conclusions: Elevated glucose during AMI hospitalization is a strong predictor of incident DM, with greater than 1 in 5 non-DM hyperglycemic patients being diagnosed with DM within 6 months after discharge. Our findings suggest that non-DM AMI patients with hyperglycemia warrant formal DM screening during or shortly after AMI hospitalization.

The role of diabetes mellitus as a risk factor of acute myocardial infarction

To determine the impact of elevated in-hospital glucose level on outcome of patients with acute myocardial infarction (AMI), and evaluate the role of diabetes mellitus as a risk factor of AMI. The study included a retrospective analysis of AMI patients who were admitted to No. 81 Hospital of PLA from January 2000 to May 2010. In patients without a history of diabetes, and those with fasting blood glucose (FBG)≥7.0 mmol/L at admission but returned to normal range soon after admission were defined as stress hyperglycemia of non-diabetic AMI patients. Both diabetic patients and non-diabetic patients were stratified into four mutually exclusive groups according to FBG levels: <7.0, 7.0-7.9, 8.0-11.0 and ≥11.1 mmol/L. The in-hospital mortality, incidence of complications, and treatment to lower glucose level were analyzed. Logistic regression analysis was conducted on risk factors of outcome of AMI patients. One hundred and fifty-two AMI patients were enrolled with 45 diabetic patients and 107 patients without previous diabetes. In diabetic group patients with FBG≥8.0 mmol/L and those with FBG≥11.1 mmol/L accounted for 73.3% (33 cases) and 46.7% (21 cases), respectively. In non-diabetic group patients with stress hyperglycemia accounted for 43.9% (47 cases), among which patients with FBG levels of 7.011.0 mmol/L accounted for 91.5% (43 cases). Compared with the non-diabetic group, the in-hospital mortality was significantly higher in diabetic group (35.6% vs. 15.9%, P=0.007). In both groups, the in-hospital mortality presented an elevating tendency with an increasing FBG level. Multivariate Logistic regression analysis demonstrated that in diabetic group patients with FBG≥8.0 mmol/L had 12.28-fold higher risk of death than patients with FBG<8.0 mmol/L, and that in non-diabetic group patients with FBG≥7.0 mmol/L had 4.81-fold higher risk of death than patients with FBG<7.0 mmol/L. FBG was an independent risk factor of death with relative odds ratio (OR) 1.03, with 95% confidence interval (95%CI) 1.01-1.16, P=0.012, and OR 1.56, 95%CI 1.09-2.23, P=0.015 in diabetic group and non-diabetic group, respectively. The incidence of congestive heart failure in diabetic group was significantly higher than that in non-diabetic group (40.0% vs. 22.4%, P=0.027). In non-diabetic group, the incidence of lung infection, congestive heart failure, serious arrhythmias and acute cerebrovascular events (51.1%, 34.0%, 27.7%, 14.9%, respectively) was increased significantly in patients with FBG≥7.0 mmol/L than that in patients with FBG<7.0 mmol/L (18.3%, 13.3%, 10.0%, 0, respectively, P<0.05 or P<0.01). This association was not seen in diabetic group. 80.0% of patients (36 cases) in diabetic group received anti-hyperglycemia treatments in which insulin therapy accounted for 63.9% (23 cases), while there was not even 1 patient who needed insulin therapy in non-diabetic patients with stress hyperglycemia. In-hospital mortality and complications were significantly increased in diabetic AMI patients and in non-diabetic AMI patients with stress hyperglycemia. Both a history of diabetes mellitus and stress hyperglycemia have strong influence on AMI prognosis. It seems to be more plausible to collaborate blood glucose level with history of diabetes in considering risk factors in AMI patients.

Admission Glucose Level and In-hospital Outcomes in Diabetic and Non-diabetic Patients with ST-elevation Acute Myocardial Infarction

Hyperglycemia on admission is a predictor of an unfavorable prognosis in patients with ST-elevation Acute Myocardial Infarction (AMI). Data concerning associations between an elevated glucose level on admission and other in-hospital complications are still limited. A total of 1,137 AMI patients with complete admission blood glucose level (ABGL) analysis were identified and stratified according to ABGL. A total of 16.1% patients had admission glucose level <5 mmol/L, 36.1% <7 mmol/L, 20.2% <9 mmol/L, 9.9% <11 mmol/L and 17.7% ≥11 mmol/L. Compared with the euglycemia group, both the hypo- and hyperglycemia groups were associated with higher in-hospital mortality. In-hospital mortality of diabetic patients with hypoglycemia (12.2%) was higher than that of diabetic patients with either euglycemia or mild hyperglycemia (11.1%, or 10.7% relatively). The same results were seen in non-diabetic patients. In the logistic regression analysis, admission glucose and cardiac function of Killip grade were the independent predictors of in-hospital death for patients with AMI. Elevated admission glucose levels are associated with an increased risk of life-threatening complications in diabetic and non-diabetic AMI patients. Compared with the euglycemia group, hypoglycemia was associated with a higher trend of in-hospital mortality.

Admission glucose level and in-hospital outcomes in diabetic and non-diabetic patients with acute myocardial infarction

Hyperglycemia on admission is a predictor of unfavorable prognosis in patients with acute myocardial infarction (AMI). Data concerning associations between elevated glucose level on admission and other in-hospital complications are still limited. A total of 607 AMI patients with complete admission glucose data in the Krakow Registry of Acute Coronary Syndromes were identified and were stratified according to glucose admission level. A total of 71.5% of patients were with admission glucose level <7.8 mmol/l, 17.6% of patients with 7.8-11.0 mmol/l, and 10.9% of patients with ≥11.1 mmol/l. In-hospital mortality for patients treated conservatively was higher in patients with higher admission glucose (8.0 vs. 25.0 vs. 39.1%, respectively, P < 0.0001), and significant mortality difference was confirmed both for diabetic and non-diabetic patients. Admission hyperglycemia was associated with increased risk of ventricular tachycardia/ventricular fibrillation, atrial fibrillation, second to third atriventricular block, pulmonary oeadema, but not ischemic stroke and blood transfusion during index hospital stay. Elevated admission glucose levels are associated with increased risk of life-threatening complications, especially arrhythmias in diabetic and non-diabetic AMI patients. This increased risk of complications is one of the possible explanations for the elevated in-hospital mortality in AMI patients presenting with hyperglycemia.