Abstract 3473: Stress Hyperglycemia is an Independent Predictor of Left Ventricular Remodeling After Inaugural Anterior Myocardial Infarction in non Diabetic Patients
Stress hyperglycemia (SH) is associated with adverse clinical outcome in patients with acute myocardial infarction (MI) but the mechanisms underlying this association are not well understood. Left ventricular remodeling (LVR) is a strong predictor of cardiovascular events after MI. We analyzed LVR in 162 non diabetic patients with anterior MI who had determination of glucose levels on admission. SH was defined as a glycemia on admission > the median value of 7 mmol/L. Systematic echocardiographic follow-up was performed at 3 months and 1 year after MI. The change in end-diastolic volume (EDV) from baseline to 1 year was 11.4 ± 16.5 ml/m2 in patients with SH vs 1.9 ± 11.1 ml/m2 in patients without SH (p <0.0001). The change in end-systolic volume (ESV) from baseline to 1 year was 6.4 ± 12.4 ml/m2 in patients with SH vs 0.2 ± 8.5 ml/m2 in patients without SH (p=0.0009). When LVR was defined as a > 20% increase in EDV between baseline and 1 year, it was observed in 31 (46%) patients in the SH group vs 13 (19%) patients in the no SH group (p=0.0008); glycemia on admission was 7.7 [6.6–9.9] mmol/L in patients with LVR vs 6.6 [6.0 – 8.2] mmol/L in patients without (p=0.004). By multivariate analysis, baseline wall motion score index (WMSI) (p=0.001) and SH (p=0.009) were independently associated with changes in EDV. SH was an independent predictor of LVR (adjusted OR: 3.22 [1.31–7.94]; p=0.01). The figure⇓ illustrates the potential interest of combining WMSI with SH to provide an estimate of the risk of LVR; the incidence of LVR in patients who had both SH on admission and a WMSI > 1.88 (median value) was 76%.
Conclusions. SH is a major and independent predictor of LVR after anterior MI in non diabetic patients.