Abstract 16859: Acute Hyperglycemia, but not Hemoglobin A1c, is Associated With Poor Outcome in Patients With Acute Myocardial Infarction
Background: Elevation of plasma glucose (PG) adversely influences outcomes of patients with acute myocardial infarction (AMI). Admission hyperglycemia and hemoglobin A1c (HbA1c) represent acute and antecedent chronic elevation of PG, respectively.
Method: This study consisted of 696 patients with AMI who admitted to National Cerebral and Cardiovascular Center, Japan within 48 hours after symptom onset between January 2007 and December 2012. PG glucose was obtained at the time of admission and acute hyperglycemia was defined as admission PG ≥200 mg/dl. HbA1c was obtained during hospitalization and antecedent chronic hyperglycemia was defined as HbA1c ≥6.5% (NGSP).
Result: Primary PCI was performed in 607 patients (87%). In-hospital mortality rate was significantly higher in patients with acute hyperglycemia than in those without (9.8% v.s. 1.6%, p<0.001). However, there was no significant difference in mortality between patients with and without antecedent chronic hyperglycemia (3.3 vs. 3.7%, p=0.79). Paradoxically, in patients with acute hyperglycemia, antecedent chronic hyperglycemia was associated with a significantly lower in-hospital mortality (5.5 vs. 18.9%, p=0.01). In multivariable analysis, admission PG was an independent predictor of in-hospital mortality (OR 1.21, 95% CI 1.09 to 1.35 for each increase of 1 mmol/l; p<0.001), but HbA1c was not.
Conclusion: These results suggested that acute hyperglycemia was associated with adverse short-term outcomes after AMI and that, in patients with acute hyperglycemia, antecedent chronic hyperglycemia might abate the adverse effects of acute hyperglycemia.
- © 2013 by American Heart Association, Inc.