Author + information
- Walid Jomaa,
- Imen Ben Ali,
- Rania Gargouri,
- Mohamed Ali Azaiez,
- Aymen El Hraiech,
- Khaldoun Ben Hamda and
- Faouzi Maatouk
Hyperglycemia on-admission has been identified as a powerful predictor of adverse outcomes in patients presenting with acute ST-elevation myocardial infarction (STEMI). Nevertheless, the prognostic value of hyperglycemia is still to be investigated in diabetic versus non-diabetic patients.
In the current study, we analyzed data from a Tunisian single center STEMI registry. Patients were enrolled between January 1998 and September 2014. Patients were managed by primary percutaneous coronary intervention, pre-hospital thrombolysis or conservatively. Hyperglycemia was defined as a serum glucose level ≥11 mmol/L. In-hospital outcomes were studied according to glycemic level then the prognostic value of hyperglycemia on admission was studied in multivariate models in diabetic and non-diabetic patients.
Out of the 1498 patients enrolled in the registry, admission glucose level was available in 1289 patients. Mean age was 60.3 ± 12.8 years and 997 (77.3%) patients were male. Hyperglycemia on-admission was reported in 485 (37.6%) patients and prevalence of known diabetes was significantly higher in hyperglycemic vs. non-hyperglycemic patients (70.2% vs. 15.2%, p<0.001). Patients with hyperglycemia were more likely to experience heart failure (27% vs. 18.8%, p=0.001), renal failure (11.8% vs. 6.1%, p<0.001) and in-hospital death (12.6% vs. 4.5%, p<0.001). In univariate analysis, hyperglycemia on-admission was significantly associated to in-hospital death in diabetic (HR: 8.85, 95% CI: 2.11-37.12, p<0.001) as well as non-diabetic patients (HR: 2.57, 95% CI: 1.39-4.74, p=0.002). In multivariate analysis, hyperglycemia on-admission was independently associated to in-hospital death in diabetic (HR: 9.6, 95% CI: 2.18-42.22, p=0.003) but not in non-diabetic patients (HR: 1.93, 95% CI: 0.97-3.86, p=0.06).
Hyperglycemia on-admission is a powerful predictor of in-hospital death in patients presenting for STEMI. Its prognostic value is higher in diabetic compared to non-diabetic patients.