Published online before print June 6, 2005, doi: 10.1161/CIRCULATIONAHA.104.517839
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2005;111:3078-3086.)
© 2005 American Heart Association, Inc.
Epidemiology |
Admission Glucose and Mortality in Elderly Patients Hospitalized With Acute Myocardial Infarction
Implications for Patients With and Without Recognized Diabetes
From the Section of Cardiovascular Medicine (M.K., S.S.R., Y.W., H.M.K.), Section of Endocrinology (S.E.I.), and the Robert Wood Johnson Clinical Scholars Program (M.K., H.M.K.), Department of Internal Medicine, and the Section of Health Policy and Administration, Department of Epidemiology and Public Health (H.M.K.), Yale University School of Medicine; Center for Outcomes Research and Evaluation, Yale–New Haven Health (H.M.K.), New Haven, Conn; and Division of Cardiology, Department of Medicine (F.A.M., E.P.H.), Denver Health Medical Center, Denver, Colo.
Correspondence to Dr Harlan M. Krumholz, Yale University School of Medicine, 333 Cedar St, PO Box 208088, New Haven, CT 06520-8088. E-mail harlan.krumholz{at}yale.edu
Received October 29, 2004; revision received February 9, 2005; accepted March 2, 2005.
Background— The relationship between admission glucose levels and outcomes in older diabetic and nondiabetic patients with acute myocardial infarction is not well defined.
Methods and Results— We evaluated a national sample of elderly patients (n=141 680) hospitalized with acute myocardial infarction from 1994 to 1996. Admission glucose was analyzed as a categorical (
110, >110 to 140, >140 to 170, >170 to 240, >240 mg/dL) and continuous variable for its association with mortality in patients with and without recognized diabetes. A substantial proportion of hyperglycemic patients (eg, 26% of those with glucose >240 mg/dL) did not have recognized diabetes. Fewer hyperglycemic patients without known diabetes received insulin during hospitalization than diabetics with similar glucose levels (eg, glucose >240 mg/dL, 22% versus 73%; P<0.001). Higher glucose levels were associated with greater risk of 30-day mortality in patients without known diabetes (for glucose range from 110 to >240 mg/dL, 10% to 39%) compared with diabetics (range, 16% to 24%; P for interaction <0.001). After multivariable adjustment, higher glucose levels continued to be associated with a graded increase in 30-day mortality in patients without known diabetes (referent, glucose 110 mg/dL; range from glucose >110 to 140 mg/dL: hazard ratio [HR], 1.17; 95% CI, 1.11 to 1.24; to glucose >240 mg/dL: HR, 1.87; 95% CI, 1.75 to 2.00). In contrast, among diabetic patients, greater mortality risk was observed only in those with glucose >240 mg/dL (HR, 1.32; 95% CI, 1.17 to 1.50 versus glucose 110 mg/dL; P for interaction <0.001). One-year mortality results were similar.
Conclusions— Elevated glucose is common, rarely treated, and associated with increased mortality risk in elderly acute myocardial infarction patients, particularly those without recognized diabetes.
Key Words: diabetes mellitus • elderly • glucose • mortality • myocardial infarction
This article has been cited by other articles:
 |
|
 |
|
  G. Van den Berghe, M. Schetz, D. Vlasselaers, G. Hermans, A. Wilmer, R. Bouillon, and D. Mesotten Intensive Insulin Therapy in Critically Ill Patients: NICE-SUGAR or Leuven Blood Glucose Target? J. Clin. Endocrinol. Metab., September 1, 2009; 94(9): 3163 - 3170. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Turchin, M. E. Matheny, M. Shubina, J. V. Scanlon, B. Greenwood, and M. L. Pendergrass Hypoglycemia and Clinical Outcomes in Patients With Diabetes Hospitalized in the General Ward Diabetes Care, July 1, 2009; 32(7): 1153 - 1157. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. S. Moghissi, M. T. Korytkowski, M. DiNardo, D. Einhorn, R. Hellman, I. B. Hirsch, S. E. Inzucchi, F. Ismail-Beigi, M. S. Kirkman, and G. E. Umpierrez American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control Diabetes Care, June 1, 2009; 32(6): 1119 - 1131. [Full Text] [PDF]
|
|
|
|
 |
|
 D. Verhaert and J. D. Thomas Dysglycemia and acute myocardial infarction the role of echocardiography. J. Am. Coll. Cardiol. Img., May 1, 2009; 2(5): 600 - 603. [Full Text] [PDF]
|
|
|
|
 |
|
 R Anantharaman, M Heatley, and C F M Weston Hyperglycaemia in acute coronary syndromes: risk-marker or therapeutic target? Heart, May 1, 2009; 95(9): 697 - 703. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kosiborod, S. E. Inzucchi, A. Goyal, H. M. Krumholz, F. A. Masoudi, L. Xiao, and J. A. Spertus Relationship Between Spontaneous and Iatrogenic Hypoglycemia and Mortality in Patients Hospitalized With Acute Myocardial Infarction JAMA, April 15, 2009; 301(15): 1556 - 1564. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kosiborod, S. E. Inzucchi, J. A. Spertus, Y. Wang, F. A. Masoudi, E. P. Havranek, and H. M. Krumholz Elevated Admission Glucose and Mortality in Elderly Patients Hospitalized With Heart Failure Circulation, April 14, 2009; 119(14): 1899 - 1907. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E. Inzucchi and M. D. Siegel Glucose Control in the ICU -- How Tight Is Too Tight? N. Engl. J. Med., March 26, 2009; 360(13): 1346 - 1349. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kosiborod, S. E. Inzucchi, H. M. Krumholz, F. A. Masoudi, A. Goyal, L. Xiao, P. G. Jones, S. Fiske, and J. A. Spertus Glucose Normalization and Outcomes in Patients With Acute Myocardial Infarction Arch Intern Med, March 9, 2009; 169(5): 438 - 446. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. R. Sinnaeve, P. G. Steg, K. A. A. Fox, F. Van de Werf, G. Montalescot, C. B. Granger, E. Knobel, F. A. Anderson, O. H. Dabbous, A. Avezum, et al. Association of Elevated Fasting Glucose With Increased Short-term and 6-Month Mortality in ST-Segment Elevation and Non-ST-Segment Elevation Acute Coronary Syndromes: The Global Registry of Acute Coronary Events Arch Intern Med, February 23, 2009; 169(4): 402 - 409. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. C. Gerstein Dysglycemia and Cardiovascular Risk in the General Population Circulation, February 17, 2009; 119(6): 773 - 775. [Full Text] [PDF]
|
|
|
|
 |
|
 C. J. Pepine Insulin as a cardiovascular therapeutic: improving glycemic control in patients with coronary artery disease. J. Am. Coll. Cardiol., February 3, 2009; 53(5 Suppl): S1 - S2. [Full Text] [PDF]
|
|
|
|
|
|
A. Polito, R. R. Thiagarajan, P. C. Laussen, K. Gauvreau, M. S.D. Agus, M. A. Scheurer, F. A. Pigula, and J. M. Costello Association Between Intraoperative and Early Postoperative Glucose Levels and Adverse Outcomes After Complex Congenital Heart Surgery Circulation, November 25, 2008; 118(22): 2235 - 2242. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kosiborod Blood glucose and its prognostic implications in patients hospitalised with acute myocardial infarction Diabetes and Vascular Disease Research, November 1, 2008; 5(4): 269 - 275. [Abstract] [PDF]
|
|
|
|
|
|
A. Goyal, K. Nerenberg, H. C Gerstein, G. Umpierrez, and P. W. Wilson Insulin therapy in acute coronary syndromes: an appraisal of completed and ongoing randomised trials with important clinical end points Diabetes and Vascular Disease Research, November 1, 2008; 5(4): 276 - 284. [Abstract] [PDF]
|
|
|
|
|
|
D. J. Wexler, D. M. Nathan, R. W. Grant, S. Regan, A. L. Van Leuvan, and E. Cagliero Prevalence of Elevated Hemoglobin A1c among Patients Admitted to the Hospital without a Diagnosis of Diabetes J. Clin. Endocrinol. Metab., November 1, 2008; 93(11): 4238 - 4244. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Goyal, R. Diaz, and S. R. Mehta Glucose-Insulin-Potassium Therapy in Patients With STEMI--Reply JAMA, May 28, 2008; 299(20): 2387 - 2388. [Full Text] [PDF]
|
|
|
|
|
|
R. A. Kloner and R. W. Nesto Glucose-Insulin-Potassium for Acute Myocardial Infarction: Continuing Controversy Over Cardioprotection Circulation, May 13, 2008; 117(19): 2523 - 2533. [Full Text] [PDF]
|
|
|
|
|
|
P. Deedwania, M. Kosiborod, E. Barrett, A. Ceriello, W. Isley, T. Mazzone, and P. Raskin Hyperglycemia and Acute Coronary Syndrome: A Scientific Statement From the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism Circulation, March 25, 2008; 117(12): 1610 - 1619. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Kosiborod, S. E. Inzucchi, H. M. Krumholz, L. Xiao, P. G. Jones, S. Fiske, F. A. Masoudi, S. P. Marso, and J. A. Spertus Glucometrics in Patients Hospitalized With Acute Myocardial Infarction: Defining the Optimal Outcomes-Based Measure of Risk Circulation, February 26, 2008; 117(8): 1018 - 1027. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Ferdinandy, R. Schulz, and G. F. Baxter Interaction of Cardiovascular Risk Factors with Myocardial Ischemia/Reperfusion Injury, Preconditioning, and Postconditioning Pharmacol. Rev., December 1, 2007; 59(4): 418 - 458. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C Weston, L Walker, J Birkhead, and National Audit of Myocardial Infarction Project, N Early impact of insulin treatment on mortality for hyperglycaemic patients without known diabetes who present with an acute coronary syndrome Heart, December 1, 2007; 93(12): 1542 - 1546. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. G Noordzij, E. Boersma, F. Schreiner, M. D Kertai, H. H H Feringa, M. Dunkelgrun, J. J Bax, J. Klein, and D. Poldermans Increased preoperative glucose levels are associated with perioperative mortality in patients undergoing noncardiac, nonvascular surgery Eur. J. Endocrinol., January 1, 2007; 156(1): 137 - 142. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. E. Inzucchi Management of Hyperglycemia in the Hospital Setting N. Engl. J. Med., November 2, 2006; 355(18): 1903 - 1911. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Ishihara, I. Inoue, T. Kawagoe, Y. Shimatani, S. Kurisu, T. Hata, Y. Nakama, Y. Kijima, and E. Kagawa Is admission hyperglycaemia in non-diabetic patients with acute myocardial infarction a surrogate for previously undiagnosed abnormal glucose tolerance? Eur. Heart J., October 2, 2006; 27(20): 2413 - 2419. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. A. Smit and J. A. Romijn Acute insulin resistance in myocardial ischemia: causes and consequences. Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2006; 10(3): 215 - 219. [Abstract] [PDF]
|
|
|
|
|
|
A. Barsheshet, M. Garty, E. Grossman, A. Sandach, B. S. Lewis, S. Gottlieb, A. Shotan, S. Behar, A. Caspi, R. Schwartz, et al. Admission Blood Glucose Level and Mortality Among Hospitalized Nondiabetic Patients With Heart Failure. Arch Intern Med, August 14, 2006; 166(15): 1613 - 1619. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The ACE/ADA Task Force on Inpatient Diabetes American College of Endocrinology and American Diabetes Association Consensus Statement on Inpatient Diabetes and Glycemic Control: A call to action Diabetes Care, August 1, 2006; 29(8): 1955 - 1962. [Full Text] [PDF]
|
|
|
|
|
|
Z. T. Bloomgarden Cardiovascular Disease Diabetes Care, May 1, 2006; 29(5): 1160 - 1166. [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Liao, S. Takashima, H. Zhao, Y. Asano, Y. Shintani, T. Minamino, J. Kim, M. Fujita, M. Hori, and M. Kitakaze Control of plasma glucose with alpha-glucosidase inhibitor attenuates oxidative stress and slows the progression of heart failure in mice Cardiovasc Res, April 1, 2006; 70(1): 107 - 116. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. B. L. Hoekstra, F. Holleman, and H. DeVries Glucose Tolerance Testing in Patients Scheduled for Cardiovascular Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2006; 10(1): 7 - 9. [Abstract] [PDF]
|
|