Abstract
Background
Impaired on-admission glucose (AG) levels in patient with acute myocardial infarction is an often finding, even in the absence of diabetes mellitus (DM) within the patient past medical records. However, data regarding the relationship between hyperglycemia and LV function in STEMI are scarce. Furthermore it is unclear whether on-admission hyperglycemia tends to have any short to mid term-prognostic significance.
Purpose
The aim of this study was to determine the relationship of on-admission hyperglycemia on myocardial damage and evaluate the Short to mid term-prognostic significance of hyperglycemia in a high-risk STEMI population.
Methods
234 Consecutive patients with STEMI who underwent primary percutaneous coronary intervention were prospectively selected. Plasma glucose level was measured on admission in all selected patients. Hyperglycemia was defined as admission plasma glucose level equal or more than 11.1 mmol/l. LV function was assessed by the measurement of EF using Simpson"s biplane method and by measurement of global longitudinal strain (GLS) using 2D speckle-tracking echocardiography (STE). The primary clinical end point was the occurrence of major adverse cardiovascular events at 60 days follow-up. Statistical analyses were performed using the SPSS 20.0 software. The value of p < 0,05 was considered as statistically significant.
Results
Patients were categorized on the basis of glucose level. 71 patients with high plasma glucose on admission were classified as a hyperglycemia group. Other 163 patients were assigned to a normoglycemia group. LV ejection fraction was significantly impaired within hyperglycemic group (44.9 ± 10,6% vs 50,4 ± 7,5%, p < 0.02), as well as, GLS was similarly impaired in hyperglycemia group (-12.9 ± 4.2% vs. -15.5 ± 3.4, p < 0.001). Occurrence of 60-days mortality was significantly higher in patients with hyperglycemia compared with normoglycemia group (10,3 % vs. 2%, p < 0.05). Multivariable linear regression analysis revealed admission glucose level is independently associated with LV GLS (B = 0.08, 96 % CI 0.04 - 0.17, p < 0.01). In multivariable logistic regression analysis was showed that admission glucose level is independently associated with 60-days mortality after adjustment of clinical variables (OR 1.10, 95% CI 1.01 - 1.25, p < 0.05).
Conclusion
Our Study reveals that on-admission hyperglycemia is strong and independent predictor of left ventricular function and 60 days mortality in patients with ST-elevation myocardial infarction .
Abstract P1438 Figure.
An analysis of the relationship between Glasgow Coma Scale score and plasma glucose level according to the severity of hypoglycemia
