Hyperglycemia at admission predicts all-cause mortality after acute MI
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Among adults without diabetes, hyperglycemia at hospital admission for acute myocardial infarction significantly increases the risk for all-cause mortality, and hyperglycemia is an independent predictor for morality, according to study data.
“We demonstrated that a blood glucose [of at least] 6.77 mmol/L was an independent predictor of all-cause death and major adverse cardiovascular and cerebrovascular events in nondiabetic acute MI patients,” Lin Cai, MD, of the department of cardiology at the Affiliated Hospital of Southwest Jiaotong University in Sichuan, China, and colleagues wrote in the Journal of Diabetes Investigation. “On the other hand, admission hyperglycemia was not an independent predictor in diabetic acute MI patients.”
Researchers conducted a retrospective, observational study of 1,288 adults (72.3% men; mean age, 67 years) admitted to 11 hospitals in Chengdu, China, with acute MI from 2014 to June 2019. The study population was divided into a diabetes group and a cohort without diabetes.
Hyperglycemia was determined by the first fasting plasma glucose value at admission. The diabetes group was divided into a hyperglycemia subgroup with blood glucose of 14.8 mmol/L or greater (266.4 mg/dL; n = 239) and a nonhyperglycemia subgroup (n = 92). Those without diabetes were placed into a hyperglycemia subgroup if they had a blood glucose level of 6.77 mmol/L or higher (121.9 mg/dL; n = 425). All other individuals without diabetes were placed into a nonhyperglycemia subgroup (n = 472). Researchers evaluated all-cause mortality and the occurrence of major adverse CV and cerebrovascular events in each subgroup, including nonfatal MI, target vessel revascularization and nonfatal stroke. All participants were followed up at outpatient clinics or through a telephone questionnaire at discharge, and then at 1, 6 and 12 months and annually thereafter.
After a mean 15 months of follow-up, 16.3% of the study population died, 0.5% had nonfatal MI, 4.4% had target vessel revascularization and 2.6% had nonfatal stroke. Hyperglycemia increased the risk for all-cause mortality in individuals with diabetes (HR = 2.84; 95% CI, 2.234-6.823; P < .001) and without diabetes (HR = 2.5; 95% CI, 1.895-3.632; P < .001). Those with hyperglycemia had an increased risk for cardiogenic death with diabetes (HR = 3.196; 95 CI%, 2.525-8.441; P < .001) and without diabetes (HR = 2.504; 95% CI, 1.884-3.661; P < .001). Hyperglycemia also increased the risk for major adverse CV and cerebrovascular events with diabetes (HR = 2.254; 95% CI, 1.752-4.638; P < .001) and without diabetes (HR = 1.985; 95% CI, 1.584-2.709; P < .001).
Regression analysis showed admission hyperglycemia was an independent predictor for all-cause mortality for individuals without diabetes, along with older age, percutaneous coronary intervention and a Killip class score of 2 or higher. For those with diabetes, only older age and percutaneous coronary intervention were identified as independent predictors for all-cause mortality.
“This work showed that admission hyperglycemia was significantly associated with a worse long-term prognosis among nondiabetic acute MI patients,” the researchers wrote. “For these patients, blood glucose should be tested after admission, and more active treatment and nursing strategies should be adopted.”
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