Admission blood glucose and adverse outcomes in non-diabetic patients with myocardial infarction in the reperfusion era

Abstract

Aims: To investigate the association between admission blood glucose levels and adverse outcomes after an incident acute myocardial infarction across a broad range of glucose levels in non-diabetic patients treated with modern therapy.

Methods: The relationship between admission blood glucose and 28-day case fatality was studied in 1348 consecutively hospitalized patients with a first-ever myocardial infarction between January 1998 and December 2002 recruited from a population-based myocardial infarction registry.

Results: Patients were divided into quartiles on the basis of admission glucose level. Patients with elevated admission blood glucose had more adverse baseline characteristics than patients with lower glucose levels. After multivariable adjustment the odds ratios (95% confidence interval) for 28-day case fatality among those in the second, third and fourth quartile in comparison to the first quartile were 1.55 (0.49-4.87), 3.21 (1.06-9.74), and 3.73 (1.28-10.92), respectively (p for trend=0.0054). Admission hyperglycemia was also associated with complications during hospital stay among 28-day survivors.

Conclusion: The risk for major complications after an incident myocardial infarction was closely related to admission blood glucose concentrations near to or within the normal range, and certainly below the diabetic threshold. Thus, admission hyperglycemia still provides an early marker of bad prognosis after an acute myocardial infarction in an era of modern therapy.