Prognostic implication of hyperglycemia in myocardial infarction and primary angioplasty.

Purpose: The study assessed the relationship of admission blood glucose level to in-hospital mortality in patients presenting with an ST-segment elevation myocardial infarction and treated with primary angioplasty.

Methods: A total of 980 patients presenting with an ST-segment elevation myocardial infarction and treated exclusively with primary angioplasty were evaluated. Patients were divided into quartiles based on their admission blood glucose level: group 1 (< or =6.6 mmol/L [< or =119 mg/dL]), group 2 (6.7-7.8 mmol/L [120-140 mg/dL]), group 3 (7.9-10.0 mmol/L [141-180 mg/dL], and group 4 (> or =10.1 mmol/L [> or =181 mg/dL]. The primary end point was in-hospital mortality.

Results: The mean age of the patient cohort was 62 years, 260 (27%) of whom were female. The mean admission blood glucose level was 9.1+/-4.4 mmol/L (164+/-79 mg/dL). At admission, 16% of this group were known to have diabetes. The in-hospital mortality rate was 3.8% (n=37), 5.2% in the diabetic group (n=8) and 3.5% (n=29) in the nondiabetic group. In-hospital mortality rates were significantly increased in patients with an elevated admission blood glucose level (P<.001). The in-hospital deaths in each admission blood glucose level quartile were 0.4% (n=1) in group 1, 2% (n=6) in group 2, 2% (n=6) in group 3, and 10% (n=24) in group 4.

Conclusions: In this cohort of patients who were admitted with an ST-segment elevation myocardial infarction and treated exclusively with primary angioplasty, elevated admission blood glucose level is significantly associated with an increase in in-hospital mortality.