Abstract 3485: Changes in Fasting Glucose During Hospitalization and Long-Term Mortality in Patients with Acute Myocardial Infarction
Introduction: Elevated fasting glucose (FG) on admission is associated with increased short-term mortality in patients with acute myocardial infarction (AMI). However, no data is available with regard to changes in FG during hospital stay and post discharge outcome.
Methods: We prospectively studied 1002 nondiabetic patients (pts) presenting with AMI. FG was obtained at admission (AFG) and prior to discharge (DFG). The pts were categorized into 4 groups:1) normal (<110 mg/dL) AFG and DFG (n = 504), 2) elevated (>110 mg/dL) AFG normal DFG n = 221), 3) normal AFG and elevated DFG (n = 86) and 4) elevated AFG and DFG (n = 191). Cox proportional hazards analyses were performed to determine the relation between categories of FG and mortality adjusting for age, creatinine, hypertension, smoking, Killip class, systolic blood pressure and heart rate on admission, anterior infarction, previous MI, reperfusion therapy and ejection fraction.
Results: The median follow-up after hospital discharge was 24 months. Kaplan-Meier survival curves according to AFG and DFG is shown in the Figure⇓. Pts with normal AFG and DFG had the lowest mortality. Pts with elevated AFG had an increased mortality even if their DFG returned to normal level (HR 2.7; 95% CI 1.6–7.4, P = 0.0003). Mortality was also increased in pts with normal AFG who developed elevated DFG (HR 2.71 95% CI 1.0–4.7, P = 0.045). Pts with persistent elevation of FG incurred the highest mortality (HR 5.3; 95% CI 3.3–8.6, P < 0.0001).
Conclusion: FG during hospital stay is a strong independent predictor of long-term mortality after hospital discharge. Even a transient elevation in FG portends increased long-term mortality.