Influence of admission plasma glucose level on short- and long-term prognosis in patients with ST-segment elevation myocardial infarction

Abstract

Background/Aim. Hyperglicemia is common in patients with ST-elevation myocardial infarction (STEMI) and is associated with high risk of mortality and morbidity. Relationship between admission plasma glucose (APG) levels and mortality in diabetic and nondiabetic patients with STEMI needs further investigation. The aim of this study was to analyse the short- and longterm prognostic significance of APG levels in patients with STEMI with and without diabetes. Methods. This study included 115 patients with STEMI, 86 (74,8%) nondiabetic and 29 (25,2%) dibaetic patients, in which we performed a prospective analysis of the relationship between APG levels and shortand long-term mortality. Results. Comparison of APG levels between nondiabetic (8.32 ? 2.4 mmol/L) and diabetic (10.09 ? 2.5 mmol/L) patients showed statistically significantly higher average APG levels in diabetic patients (p = 0.001). In all patients observed who died either after one month or one year after STEMI, average APG values were significantly higher in comparison with those in survived patients. There was no statistical significance in average APG levels in the diabetic patients with STEMI who died after one month and those who survived (10.09 ? 2.68 vs 10.0 ? 2.51 mmol/L, respectively; p = 0.657), as well as those who died after one year and those who survived (10.1 ? 1.92 vs 10.09 ? 2.8 mmol/L, respectively; p = 0.996). There was, however, statistical significance in average APG levels in the nondiabetic patients with STEMI who died after one month and those who survived (9.97 ? 2.97 vs 7.91 ? 2.08 mmol/L, respectively; p = 0.001), as well as those who died after one year and those who survived (9.17 ? 2.49 vs 7.84 ? 2.24 mmol/L, respectively; p = 0.013). Conclusion. Acute hyperglicemia in the settings of STEMI worsenes the prognosis in patients with and without diabetes. Our study showed that nondiabetic patients with high APG levels are at higher risk of mortality than patients with a known history of diabetes.Uvod/Cilj. Hiperglikemija se javlja kod bolesnika sa STelevacijom infarkta miokarda (STEMI) i dovodi se u vezu sa visokim rizikom od mortaliteta i morbiditeta. Veza izmedju nivoa glukoze u plazmi na prijemu (APG) i mortaliteta kod dijabeticara i nedijabeticara sa STEMI zahteva dalje istrazivanje. Cilj ove studije bio je analiza kratkorocne i dugorocne prognosticke znacajnosti APG kod bolesnika STEMI sa i bez dijagnostikovanog dijabetesa. Metode. Ova studija obuhvatila je 115 bolesnika sa STEMI 86 (74,8%) nedijabeticara i 29 (25,2%) dijabeticara, kod kojih je izvrsena prospektivna analiza veze izmedju APG i kratko- i dugorocnog mortaliteta. Rezultati. Uporedjivanje APG kod nedijabeticara (8,32 ? 2,4 mmol/L) i dijabeticara (10,09 ? 2,5 mmol/L) pokazalo je statisticki znacajno visi prosecni nivo APG kod dijabeticara (p = 0,001). Kod svih bolesnika sa STEMI koji su umrli posle jednog meseca ili jedne godine prosecni nivo APG bio je znacajno visi nego kod onih koji su preziveli. Nije nadjena statisticka znacajnost u prosecnom nivou APG kod dijabeticara sa STEMI koji su umrli posle mesec dana i onih koji su preziveli (10,09 ? 2,68 vs 10,0 ? 2,51 mmol/L; p = 0,657), kao ni onih koji su umrli posle godinu dana i onih koji su preziveli (10,1 ? 1,92 vs 10,09 ? 2,8 mmol/L; p = 0,996). Nadjena je, medjutim, statisticka znacajnost u prosecnom nivou APG kod nedijabeticara sa STEMI koji su umrli posle mesec dana i onih koji su preziveli (9,97?2,97 vs 7,91 ? 2,08 mmol/L; p = 0,001), kao i onih koji su umrli posle godinu dana i onih koji su preziveli (9,17 ? 2,49 vs 7,84 ? 2,24 mmol/L; p = 0,013). Zakljucak. Akutna hiperglikemija u prisustvu STEMI pogorsava prognozu i kod bolesnika sa dijabetesom i kod onih bez dijabetesa. Pokazano je da su nedijabeticari sa visokim nvoom APG u visem riziku od mortaliteta, nego bolesnici sa istorijom dijabetesa.