Background: In patients with acute myocardial infarction(MI), increased plasma glucose levels at hospital admission are associated with worse outcome. We aimed to assess the predictive value of admission glucose conce...Background: In patients with acute myocardial infarction(MI), increased plasma glucose levels at hospital admission are associated with worse outcome. We aimed to assess the predictive value of admission glucose concentrations on short- and long-term mortality in patients with acute MI undergoing primary or rescue percutaneous coronary intervention(PCI). Methods: We analyzed the 30-day and long-term(mean follow-up 3.7 years)outcome of 978 patients prospectively included in a single-center registry of patients with acute MI treated with PCI within 24 hours after onset of symptoms. Patients were classified according to plasma glucose levels at admission:< 7.8 mmol/L(group I, n=322), 7.8 to 11 mmol/L(group II, n=348), and >11.0 mmol/L(group III, n=308). Results: Mortality at 30 days was 1.2% in group I, 6.3% in group II, and 16.6% in group III(P< .001). After multivariate adjustment for age, the presence of cardiogenic shock, and TIMI 3 flow after PCI, the association of mortality with glucose classification remained significant(P value for trend=.003). The relative risk of death at 30 days for group III versus group I was 3.9(95% CI 1.2- 13.2). During long-term follow-up, mortality was similar in groups I and II. However, in group III adjusted mortality remained significantly increased compared with group I(relative risk 1.76, CI 1.01- 3.08). Conclusions: In patients undergoing emergency PCI for acute MI, glucose levels at hospital admission are predictive for short- and long-term survival. Knowledge of admission glucose levels may improve initial bedside risk stratification.展开更多
文摘Background: In patients with acute myocardial infarction(MI), increased plasma glucose levels at hospital admission are associated with worse outcome. We aimed to assess the predictive value of admission glucose concentrations on short- and long-term mortality in patients with acute MI undergoing primary or rescue percutaneous coronary intervention(PCI). Methods: We analyzed the 30-day and long-term(mean follow-up 3.7 years)outcome of 978 patients prospectively included in a single-center registry of patients with acute MI treated with PCI within 24 hours after onset of symptoms. Patients were classified according to plasma glucose levels at admission:< 7.8 mmol/L(group I, n=322), 7.8 to 11 mmol/L(group II, n=348), and >11.0 mmol/L(group III, n=308). Results: Mortality at 30 days was 1.2% in group I, 6.3% in group II, and 16.6% in group III(P< .001). After multivariate adjustment for age, the presence of cardiogenic shock, and TIMI 3 flow after PCI, the association of mortality with glucose classification remained significant(P value for trend=.003). The relative risk of death at 30 days for group III versus group I was 3.9(95% CI 1.2- 13.2). During long-term follow-up, mortality was similar in groups I and II. However, in group III adjusted mortality remained significantly increased compared with group I(relative risk 1.76, CI 1.01- 3.08). Conclusions: In patients undergoing emergency PCI for acute MI, glucose levels at hospital admission are predictive for short- and long-term survival. Knowledge of admission glucose levels may improve initial bedside risk stratification.
