scholarly journals The association of diabetes and admission blood glucose with 30-day mortality in patients with acute myocardial infarction complicated by cardiogenic shock

2020 ◽  
Vol 9 (6) ◽  
pp. 626-635
Author(s):  
Michael Thoegersen ◽  
Jakob Josiassen ◽  
Ole KL Helgestad ◽  
Hanne Berg Ravn ◽  
Henrik Schmidt ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Cardiogenic Shock ◽  
Type I ◽  
Glucose Levels ◽  
Diabetes Patients

Background Cardiogenic shock is the leading cause of death in patients with acute myocardial infarction, with short-term mortality of approximately 50%. Whether diabetes mellitus and high blood glucose levels are associated with mortality in contemporary patients with acute myocardial infarction complicated by cardiogenic shock is inadequately described. Purpose To investigate if diabetes mellitus and high admission blood glucose were associated with 30-day mortality in a large, contemporary population with acute myocardial infarction complicated by cardiogenic shock. Methods Patients with acute myocardial infarction complicated by cardiogenic shock admitted at two tertiary centres in Denmark from 2010 to 2017 were individually identified through patient charts, resulting in the inclusion of 1716 cardiogenic shock patients. Glucose level at admission to the intensive care unit was available in 1302 patients. Results There was no significant difference in 30-day mortality between diabetes mellitus types I and II (63% vs. 62%, NS). Thirty-day mortality was significantly higher in diabetes patients compared to non-diabetes patients (62% vs. 50%, P < 0.001). Increasing admission glucose was associated with increasing 30-day mortality in a dose-dependent manner in diabetes mellitus (4–8 mmol/L, 41%; 8–12 mmol/L, 49%; 12–16 mmol/L, 63%; >16 mmol/L, 67%; P = 0.028) and non-diabetes patients (4–8 mmol/L, 32%; 8–12 mmol/L, 43%; 12–16 mmol/L, 57%; >16 mmol/l; 68%; P < 0.001). Conclusion Patients with acute myocardial infarction complicated by cardiogenic shock and concomitant diabetes mellitus type I or II had a significantly higher 30-day mortality in comparison to patients without diabetes mellitus, whereas no difference was found between diabetes mellitus types I and II. High glucose levels on admission to the intensive care unit were associated with increased 30-day mortality in diabetes mellitus and non-diabetes mellitus patients.

scholarly journals Establishment of a prognostic model based on the Sequential Organ Failure Assessment score for patients with first-time acute myocardial infarction

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110119
Author(s):  
Shuai Zheng ◽  
Jun Lyu ◽  
Didi Han ◽  
Fengshuo Xu ◽  
Chengzhuo Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Cardiovascular Events ◽  
Failure Assessment ◽  
First Time

Objective This study aimed to identify the prognostic factors of patients with first-time acute myocardial infarction (AMI) and to establish a nomogram for prognostic modeling. Methods We studied 985 patients with first-time AMI using data from the Multi-parameter Intelligent Monitoring for Intensive Care database and extracted their demographic data. Cox proportional hazards regression was used to examine outcome-related variables. We also tested a new predictive model that includes the Sequential Organ Failure Assessment (SOFA) score and compared it with the SOFA-only model. Results An older age, higher SOFA score, and higher Acute Physiology III score were risk factors for the prognosis of AMI. The risk of further cardiovascular events was 1.54-fold higher in women than in men. Patients in the cardiac surgery intensive care unit had a better prognosis than those in the coronary heart disease intensive care unit. Pressurized drug use was a protective factor and the risk of further cardiovascular events was 1.36-fold higher in nonusers. Conclusion The prognosis of AMI is affected by age, the SOFA score, the Acute Physiology III score, sex, admission location, type of care unit, and vasopressin use. Our new predictive model for AMI has better performance than the SOFA model alone.

scholarly journals HYPERGLYCEMIA IN ACUTE MYOCARDIAL INFARCTION: PROGNOSTIC MEANING AND NUTRITIVE CORRECTION

2018 ◽  
Vol 19 (1) ◽  
pp. 20-24
Author(s):  
O. V. Аlekseenko ◽  
V. M. Luft
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Intensive Care Unit ◽  
Emergency Medicine ◽  
Intensive Care ◽  
Target Values ◽  
Different Types

Currently the emergency medicine turned on the wide use of the special enteral nutritional cocktails like “Diabetes” to manage different types of hyperglycemia under various acute disorders. Under the conditions of resuscitation and intensive care unit (RICU) there looked into the possibility and efficacy of early monitoring of the hyperglycemia target values using the special enteral nutritional cocktails with the MI patients.

ASSESSMENT OF BIOCHEMICAL PARAMETERS IN DIABETIC AND NON-DIABETIC ACUTE MYOCARDIAL INFARCTION PATIENTS

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Darshna Jain
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Blood Glucose ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Creatine Phosphokinase ◽  
Density Lipoprotein ◽  
Normal Blood ◽  
Cardiac Markers

Background: The present study was design to assess the level of altered lipid profile, lipoprotein sub fractions, oxidative stress and antioxidants in coronary artery disease with type-2 diabetes mellitus’s patients and non diabetic patients. Methods: This case–control study included 300 subjects; out of which, 100 subjects were with normal blood glucose level and with normal ECG (Normal, N), 100 subjects  were with normal blood glucose level and AMI (non-diabetic and AMI, N-AMI) and 100 subjects were with diabetes and AMI (Diabetic and AMI, D-AMI) Results: D-AMI individuals had high level of total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL), and low level of high density lipoprotein (HDL) in comparison to N-AMI individuals. The cardiac markers such as Troponin I, creatine phosphokinase (CPK), creatine kinase-MB (CK-MB), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and C-reactive protein (CRP) levels were significantly increased in patients suffering from myocardial infarction with diabetes mellitus (DM) compared to patients of myocardial infarction without DM. The antioxidant superoxide dismutase (SOD) and glutathione (GSH) were lower in D-AMI patients than in N-AMI. However, levels of malondialdehyde (MDA) and catalase (CAT) were higher in D-AMI than in N-AMI controls. Conclusion: Our study suggested that patients with D-AMI have elevated cardiac markers and reduced antioxidants levels as compared to N-AMI patient. Keywords: Diabetes Mellitus, Acute Myocardial Infarction, Creatine Phosphokinase, Glutathione

scholarly journals Impact of elevated HbA1c on long-term mortality in patients presenting with acute myocardial infarction in daily clinical practice: insights from a ‘real world’ prospective registry of the Zwolle Myocardial Infarction Study Group

2019 ◽  
Vol 9 (6) ◽  
pp. 616-625 ◽  
Author(s):  
Renicus S Hermanides ◽  
Mark W Kennedy ◽  
Elvin Kedhi ◽  
Peter R van Dijk ◽  
Jorik R Timmer ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Clinical Outcome ◽  
Newly Diagnosed ◽  
Diagnosed Diabetes ◽  
Newly Diagnosed Diabetes ◽  
Long Term Mortality ◽  
Diabetes Patients

Background: Long-term clinical outcome is less well known in up to presentation persons unknown with diabetes mellitus who present with acute myocardial infarction and elevated glycosylated haemoglobin (HbA1c) levels on admission. We aimed to study the prognostic impact of deranged HbA1c at presentation on long-term mortality in patients not known with diabetes, presenting with acute myocardial infarction. Methods: A single-centre, large, prospective observational study in patients with and without known diabetes admitted to our hospital for ST-segment elevation myocardial infarction (STEMI) and non-STEMI. Newly diagnosed diabetes mellitus was defined as HbA1c of 48 mmol/l or greater and pre-diabetes mellitus was defined as HbA1c between 39 and 47 mmol/l. The primary endpoint was all-cause mortality at short (30 days) and long-term (median 52 months) follow-up. Results: Out of 7900 acute myocardial infarction patients studied, 1314 patients (17%) were known diabetes patients. Of the 6586 patients without known diabetes, 3977 (60%) had no diabetes, 2259 (34%) had pre-diabetes and 350 (5%) had newly diagnosed diabetes based on HbA1c on admission. Both short-term (3.9% vs. 7.4% vs. 6.0%, p<0.001) and long-term mortality (19% vs. 26% vs. 35%, p<0.001) for both pre-diabetes patients as well as newly diagnosed diabetes patients was poor and comparable to known diabetes patients. After multivariate analysis, newly diagnosed diabetes was independently associated with long-term mortality (hazard ratio 1.72, 95% confidence interval 1.27–2.34, P=0.001). Conclusions: In the largest study to date, newly diagnosed or pre-diabetes was present in 33% of acute myocardial infarction patients and was associated with poor long-term clinical outcome. Newly diagnosed diabetes (HbA1c ⩾48 mmol/mol) is an independent predictor of long-term mortality. More attention to early detection of diabetic status and initiation of blood glucose-lowering treatment is necessary.

scholarly journals Postoperative hypotension in patients discharged to the intensive care unit after non-cardiac surgery is associated with adverse clinical outcomes

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Nathan J. Smischney ◽  
Andrew D. Shaw ◽  
Wolf H. Stapelfeldt ◽  
Isabel J. Boero ◽  
Qinyu Chen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Kidney Injury ◽  
Intraoperative Hypotension ◽  
Cerebrovascular Events ◽  
Acute Kidney Injury Stage

Abstract Background The postoperative period is critical for a patient’s recovery, and postoperative hypotension, specifically, is associated with adverse clinical outcomes and significant harm to the patient. However, little is known about the association between postoperative hypotension in patients in the intensive care unit (ICU) after non-cardiac surgery, and morbidity and mortality, specifically among patients who did not experience intraoperative hypotension. The goal of this study was to assess the impact of postoperative hypotension at various absolute hemodynamic thresholds (≤ 75, ≤ 65 and ≤ 55 mmHg), in the absence of intraoperative hypotension (≤ 65 mmHg), on outcomes among patients in the ICU following non-cardiac surgery. Methods This multi-center retrospective cohort study included specific patient procedures from Optum® healthcare database for patients without intraoperative hypotension (MAP ≤ 65 mmHg) discharged to the ICU for ≥ 48 h after non-cardiac surgery with valid mean arterial pressure (MAP) readings. A total of 3185 procedures were included in the final cohort, and the association between postoperative hypotension and the primary outcome, 30-day major adverse cardiac or cerebrovascular events, was assessed. Secondary outcomes examined included all-cause 30- and 90-day mortality, 30-day acute myocardial infarction, 30-day acute ischemic stroke, 7-day acute kidney injury stage II/III and 7-day continuous renal replacement therapy/dialysis. Results Postoperative hypotension in the ICU was associated with an increased risk of 30-day major adverse cardiac or cerebrovascular events at MAP ≤ 65 mmHg (hazard ratio [HR] 1.52; 98.4% confidence interval [CI] 1.17–1.96) and ≤ 55 mmHg (HR 2.02, 98.4% CI 1.50–2.72). Mean arterial pressures of ≤ 65 mmHg and ≤ 55 mmHg were also associated with higher 30-day mortality (MAP ≤ 65 mmHg, [HR 1.56, 98.4% CI 1.22–2.00]; MAP ≤ 55 mmHg, [HR 1.97, 98.4% CI 1.48–2.60]) and 90-day mortality (MAP ≤ 65 mmHg, [HR 1.49, 98.4% CI 1.20–1.87]; MAP ≤ 55 mmHg, [HR 1.78, 98.4% CI 1.38–2.31]). Furthermore, we found an association between postoperative hypotension with MAP ≤ 55 mmHg and acute kidney injury stage II/III (HR 1.68, 98.4% CI 1.02–2.77). No associations were seen between postoperative hypotension and 30-day readmissions, 30-day acute myocardial infarction, 30-day acute ischemic stroke and 7-day continuous renal replacement therapy/dialysis for any MAP threshold. Conclusions Postoperative hypotension in critical care patients with MAP ≤ 65 mmHg is associated with adverse events even without experiencing intraoperative hypotension.

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