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Hyperglycemia at hospitalization of patients with ST-segment elevation myocardial infarction as a marker for unfavorable prognosis

Panina A. V., Dovgalevsky Ya. P., Dolotovskaya P. V., Furman N. V., Puchinjyan N. F.

Keywords: hyperglycemia, ST-segment elevation myocardial infarction, prognosis, risk factors

DOI: 10.18087/rhj.2014.2.1887

Background. The role of hyperglycemia in development of cardiovascular complications in patients with acute ST-segment elevation MI (STEMI) is still not completely clear. Aim. To evaluate the significance of glycemia at admission as a predictor of complications and unfavorable outcome in patients with STEMI in the absence of DM. Materials and methods. The study included 335 patients (259 males and 76 females) admitted to the emergency cardiology department for STEMI. All patients were divided into groups based on the history of DM: patients without DM (301 patients) and with DM (34 patients including patients with newly diagnosed DM). For evaluation of the effect of glycemia on the STEMI course and prognosis, patients without DM were subdivided into 2 subgroups based on the blood glucose level at admission: with blood glucose <6.1 mmol / l (270 patients) and ≥6.1 mmol / l (31 patients). Results. The presence of DM was associated with a significantly higher risk of death during hospitalization compared to patients without DM irrespective of the blood glucose level at admission (OR, 6.6 [95 % CI, 1.75–24.5], р=0.0052). The same was true for patients with impaired glucose metabolism including DM or hyperglycemia at admission (combined groups 1b and 2) compared to patients without DM or hyperglycemia (group 1a) [OR, 6.76 (95 % CI, 1.85–24.7), р=0.0038]. Patients with hyperglycemia at admission (group 1b) had higher risk of fatal outcome during hospitalization than patients with normoglycemia and without DM (group 1а) [OR, 4.6 (95 % CI, 0.8–26.1), р=0.078]. Patients with increased blood glucose levels and patients with earlier documented DM were not significantly different in the long-term prognosis although all-cause death, recurrent MI, unstable angina, and acute HF were somewhat more frequently observed in patients without DM and with hyperglycemia at admission within one year after the discharge from the hospital. Conclusion. Obviously, MI patients with hyperglycemia at admission without DM should be considered at high risk for complications and unfavorable outcome. Evaluation for hyperglycemia at admission of a STEMI patient without DM apparently can be used as an additional factor for risk stratification.
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Panina A. V., Dovgalevsky Ya. P., Dolotovskaya P. V. et al. Hyperglycemia at hospitalization of patients with ST-segment elevation myocardial infarction as a marker for unfavorable prognosis. Russian Heart Journal. 2014;76 (2):67–73

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