Abstract 2604: Hyperglycemia At Hospital Admission In Patients With Acute ST-Elevation Myocardial Infarction Is Associated With A Poor Prognosis Due To Impaired Myocardial Perfusion
Purpose: Elevated glucose serum levels at hospital admission are associated with a poor short-and long-term term prognosis in patients with acute ST-elevation myocardial infarction (STEMI). The mechanisms of this observation are not fully understood yet.
Methods: The patient population comprised 251 consecutive patients with acute ST-elevation myocardial infarction and successful primary percutaneous coronary intervention (PPCI). The post-procedural TIMI myocardial blush-grade (TMBG) was assessed in all patients and served as a surrogate angiographic marker for myocardial perfusion and microvascular integrity. Glucose serum levels were measured at hospital admission. Major adverse cardiac events were defined by death, acute myocardial infarction and repeat revascularisation and assessed in all patients 24±6 months post intervention.
Results: The median blood-level of glucose at admission was 165±56 mg/dl. Patients with preserved myocardial perfusion (TMBG 2 and 3) after PPCI presented with median glucose levels of 159±50 mg/dl at admission as compared to 178±63 mg/dl in patients with impaired myocardial perfusion (TMBG 0 and 1) (p=0.01). Glucose levels above the median at admission were independently associated with a lower short- and long-term event-free survival (Figure 1⇓).
Conclusion: Elevated glucose serum levels at admission in patients with acute STEMI and successful PPCI are associated with an impairment in myocardial perfusion after successful PPCI and a poor short- and long-term prognosis. The impact of an intensified insulin therapy in this context is subject to current clinical studies.