on June 6, 2005
Published online before print June 6, 2005, doi: 10.1161/CIRCULATIONAHA.104.517839
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Submitted on October 29, 2004
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. * To whom correspondence should be addressed. E-mail: harlan.krumholz{at}yale.edu.
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 ( Conclusions--Elevated glucose is common, rarely treated, and associated with increased mortality risk in elderly acute myocardial infarction patients, particularly those without recognized diabetes.
Revised on February 9, 2005
Accepted on March 2, 2005
Admission Glucose and Mortality in Elderly Patients Hospitalized With Acute Myocardial Infarction. Implications for Patients With and Without Recognized Diabetes
Mikhail Kosiborod MD,
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.
Key words: diabetes mellitus • elderly • glucose • mortality • myocardial infarction
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