this issue
previous article in this issuenext article in this issue

Document Details :

Title: Which is worst in patients undergoing primary angioplasty for acute myocardial infarction? Hyperglycaemia? Diabetes mellitus? Or both?
Author(s): M. Ergelen , H. Uyarel , G. CIcek , T. Isik , D. Osmonov , Z.Y. Gunaydin , M. Bozbay , A. Turer , M. Gul , G.B. Abanonu , E. Ilhan
Journal: Acta Cardiologica
Volume: 65    Issue: 4   Date: 2010   
Pages: 415-423
DOI: 10.2143/AC.65.4.2053900

Abstract :
Objective — The objective of this study was to evaluate the effect of admission hyperglycaemia and/or diabetes mellitus (DM) on the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
Methods — 2482 consecutive patients with STEMI (mean age 56.5 ± 11.9, years, 2064 men) undergoing primary PCI between October 2003 and March 2008 were retrospectively enrolled into the present study. Hyperglycaemia was defined as a venous plasma glucose level > 200 mg/dl on admission. Patients were classified into four groups: non-diabetic/non-hyperglycaemic (NDNH, n = 1806) patients; diabetic/non-hyperglycaemic (DNH, n = 271) patients; non-diabetic/hyperglycaemic (NDH, n = 64); and diabetic/hyperglycaemic (DH, n = 341).
Results — In-hospital mortality was higher in NDH (12.5%) compared to DH (8.5%), DNH (6.3%), and NDNH (0.9%) patients (P < 0.001). The composite end points including death, reinfarction, and target-vessel revascularization (major adverse cardiac events [MACE]) in the hospital were also higher in NDH (18.8%) compared with other patients (DH, 13.8% vs. DNH, 10.3% vs. NDNH, 3.7%, P < 0.001). The median follow-up time was 21 months. The Kaplan-Meier survival plot for long-term cardiovascular death was worst for DH patients (log rank P < 0.001). After adjustment for potentially confounding factors, NDH (OR 3.04, 95% CI 1.06-8.73; P = 0.03), and DH (OR 2.3, 95% CI 1.29-4.09; P = 0.005), but not DNH (OR 1.22, 95% CI 0.57-2.6; <P = 0.6) status, remained independent predictors of long-term cardiovascular mortality.
Conclusions — STEMI patients with NDH represent the highest risk population for in-hospital mortality, and MACE. The worst outcomes for long-term cardiovascular mortality occur in DH patients.