Hyperglycemia at admission predicts mortality in patients with acute myocardial infarction: BMJ

Acute myocardial infarction is one of the leading mortality and morbidity disease in the world. The mortality rate of AMI remains high despite betterment in clinical outcomes of AMI through drug use and timely and effective revascularization. In critically ill patients, hyperglycemia is a common occurrence, and more evidence has shown that it is tied to mortality and severity of the disease. Hyperglycemia at hospital admission is a prognostic factor of poor short-term prognosis in AMI patients.

Against the above background, Linlin Liu, Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China, and colleagues aimed to examine the significant cut-off value of admission blood glucose for predicting unfavorable events in AMI patients with or without diabetes. Also, they sought to provide clinicians with a trigger point for glucose-lowering therapy.

For this purpose, the researchers retrospectively reviewed 2027 AMI patients admitted in the 'Medical Information Mart for Intensive Care III database from June 2001 to December 2012. Using the receiver operating characteristic (ROC) curve, significant cut-off values of admission blood glucose (Glucose_0) were obtained for predicting hospital mortality in AMI patients with and without diabetes. The patients were then assigned to hyperglycemia and non-hyperglycemia groups based on corresponding cut-off values. The primary endpoints of the study were the hospital and 1-year mortality.

Based on the study, the researchers found the following:

• Among 2027 patients, death occurred in 15.3% of the patients.
• The significant cut-off values of Glucose_0 for predicting hospital mortality, respectively, were 224.5 and 139.5 mg/dL in patients with diabetes and without diabetes, according to the ROC curve.
• The crude hospital and 1-year mortality of the hyperglycemia subgroup were higher than the corresponding non-hyperglycemia group.
• After adjustment, regardless of diabetes state, hyperglycemia at admission was related to significantly increased hospital mortality in patients with AMI.
• For AMI patients without diabetes, hyperglycemia at admission was positively correlated with the increase in 1-year mortality (HR, 1.47). Nevertheless, this trend disappeared in those with diabetes (HR, 1.35).

To conclude, the researchers found a similar predictive value of hyperglycemia at admission among patients with and without diabetes with AMI for hospital mortality. However, concerning long-term prognosis, hyperglycemia at entry was an independent predictor of AMI patients without diabetes than those with diabetes.

"For patients without diabetes with AMI, effective and timely hypoglycemic treatment strategies and nursing measures are critical," the researchers conclude.

Reference:

Liu L, Qian J, Yan W, et al. Relationship between hyperglycaemia at admission and prognosis in patients with acute myocardial infarction: a retrospective cohort study. Postgraduate Medical Journal Published Online First: 20 September 2022. doi: 10.1136/pmj-2021-141454