Advertisement

Comparison of Blood Glucose Values on Admission for Acute Myocardial Infarction in Patients With Versus Without Diabetes Mellitus

      Previous studies have reported that acute hyperglycemia is associated with high mortality after acute myocardial infarction (AMI). However, optimal plasma glucose level may be different between diabetic and nondiabetic patients. The purpose of this study was to assess the relation between admission glucose and in-hospital mortality after AMI in patients with and without diabetes. This study consisted of 3,750 patients who were admitted to the 35 hospitals participating to the Japanese Acute Coronary Syndrome Study (JACSS) group within 48 hours after the onset of AMI. Plasma glucose was measured at the time of hospital admission. In patients without a history of diabetes, there was a linear relation between admission glucose and in-hospital mortality. Nondiabetic patients with a glucose level <6 mmol/L had the lowest mortality (2.5%). As admission glucose increased by 1 mmol/L, mortality increased by 17% (13% to 21%, p <0.001). In patients with a history of diabetes, however, there was a U-shape relation between glucose and mortality. Diabetic patients with glucose 9 to 10 mmol/L had the lowest mortality (1.9%); not only severe hyperglycemia (glucose ≥11 mmol/L, 9.1%, p <0.001) but also euglycemia (glucose <7 mmol/L, 9.4%, p = 0.009) were associated with higher mortality compared to moderate hyperglycemia (glucose 9 to 11 mmol/L, 3.2%). Diabetic patients with admission glucose 9 to 10 mmol/L had the lowest mortality, whereas lower glucose was better in nondiabetic patients. In conclusion, optimal glucose level on admission may be different between diabetic and nondiabetic patients with AMI.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Capes S.E.
        • Hunt D.
        • Malmberg K.
        • Gerstein H.C.
        Stress hyperglycemia and increased risk after myocardial infarction in patients without diabetes: a systematic overview.
        Lancet. 2000; 355: 773-778
        • Wahab N.N.
        • Cowden E.A.
        • Pearce N.J.
        • Gardner M.J.
        • Merry H.
        • Cox J.L.
        • ICONS Investigators
        Is blood glucose an independent predictor of mortality in acute myocardial infarction in the thrombolytic era?.
        J Am Coll Cardiol. 2002; 40: 1748-1754
        • Stranders I.
        • Diamant M.
        • van Gelder R.E.
        • Spruijt H.J.
        • Twisk J.W.
        • Heine R.J.
        • Visser F.C.
        Admission blood glucose level as risk indicator of death after myocardial infarction in patients with and without diabetes mellitus.
        Arch Intern Med. 2004; 164: 982-988
        • Kosiborod M.
        • Rathore S.S.
        • Inzucchi S.E.
        • Masoudi F.A.
        • Wang Y.
        • Havranek E.P.
        • Krumholz H.M.
        Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction.
        Circulation. 2005; 111: 3078-3086
        • Ishihara M.
        • Kojima S.
        • Sakamoto T.
        • Asada Y.
        • Tei C.
        • Kimura K.
        • Miyazaki S.
        • Sonoda M.
        • Tsuchihashi K.
        • Yamagishi M.
        • Ikeda Y.
        • Shirai M.
        • Hiraoka H.
        • Inoue T.
        • Saito F.
        • Ogawa H.
        • Japanese Acute Coronary Syndrome Study (JACSS) Investigators
        Acute hyperglycemia is associated with adverse outcome after acute myocardial infarction in the coronary intervention era.
        Am Heart J. 2005; 150: 814-820
        • Svensson A.M.
        • McGuire D.K.
        • Abrahamsson P.
        • Dellborg M.
        Association between hyper- and hypoglycaemia and 2 year all-cause mortality risk in diabetic patients with acute coronary events.
        Eur Heart J. 2005; 26: 1255-1261
        • Kosiborod M.
        • Inzucchi S.E.
        • Krumholz H.M.
        • Xiao L.
        • Jones P.G.
        • Fiske S.
        • Masoudi F.A.
        • Marso S.P.
        • Spertus J.A.
        Glucometrics in patients hospitalized with acute myocardial infarction: defining the optimal outcomes-based measure of risk.
        Circulation. 2008; 117: 1018-1027
        • Pinto D.S.
        • Skolnick A.H.
        • Kirtane A.J.
        • Murphy S.A.
        • Barron H.V.
        • Giugliano R.P.
        • Cannon C.P.
        • Braunwald E.
        • Gibson C.M.
        • TIMI Study Group
        U-shaped relationship of blood glucose with adverse outcomes among patients with ST-segment elevation myocardial infarction.
        J Am Coll Cardiol. 2005; 46: 178-180
        • Deedwania P.
        • Kosiborod M.
        • Barrett E.
        • Ceriello A.
        • Isley W.
        • Mazzone T.
        • Raskin P.
        Hyperglycemia and acute coronary syndrome: a scientific statement from the American Heart Association diabetes committee of the council on nutrition, physical activity, and metabolism.
        Circulation. 2008; 117: 1610-1619
        • Matsuo S.
        • Imai E.
        • Horio Y.
        • Yasuda Y.
        • Tomita K.
        • Nitta K.
        • Yamagata K.
        • Tomino Y.
        • Yokoyama H.
        • Hishida A.
        • collaborators for developing Japanese equation for estimating GFR
        Revised equation for estimated GFR from serum creatinine in Japan.
        Am J Kidney Dis. 2009; 53: 982-992
        • Ishihara M.
        • Inoue I.
        • Kawagoe T.
        • Shimatani Y.
        • Kurisu S.
        • Nishioka Y.
        • Nakamura Y.
        • Yoshida M.
        Effect of acute hyperglycemia on the ischemic preconditioning effect of prodromal angina pectoris in patients with an anterior wall first acute myocardial infarction.
        Am J Cardiol. 2003; 92: 288-291
        • Ceriello A.
        • Quagliaro L.
        • D'Amico M.
        • Di Filippo C.
        • Marfella R.
        • Nappo F.
        • Berrino L.
        • Rossi F.
        • Giugliano D.
        Acute hyperglycemia induces nitrotyrosine formation and apoptosis in perfused heart from rat.
        Diabetes. 2002; 51: 1076-1082
        • Williams S.B.
        • Goldfine A.B.
        • Timimi F.K.
        • Roddy M.A.
        • Simonson D.C.
        • Creager M.A.
        Acute hyperglycemia attenuates endothelium-dependent vasodilation in human in vivo.
        Circulation. 1998; 97: 1695-1701
        • Worthley M.I.
        • Holmes A.S.
        • Willoughby S.R.
        • Kucia A.M.
        • Heresztyn T.
        • Stewart S.
        • Chirkov Y.Y.
        • Zeitz C.J.
        • Horowitz J.D.
        The deleterious effects of hyperglycemia on platelet function in diabetic patients with acute coronary syndromes.
        J Am Coll Cardiol. 2007; 49: 304-310
        • Ceriello A.
        Coagulation activation in diabetes mellitus: the role of hyperglycemia and therapeutic prospects.
        Diabetologia. 1993; 36: 1119-1125
        • Iwakura K.
        • Ito H.
        • Ikushima M.
        • Kawano S.
        • Okamura A.
        • Asano K.
        • Kuroda T.
        • Tanaka K.
        • Masuyama T.
        • Hori M.
        • Fujii K.
        Association between hyperglycemia and the no-reflow phenomenon in patients with acute myocardial infarction.
        J Am Coll Cardiol. 2003; 41: 1-7
        • Ishihara M.
        • Inoue I.
        • Kawagoe T.
        • Shimatani Y.
        • Kurisu S.
        • Nishioka K.
        • Kouno Y.
        • Umemura T.
        • Nakamura T.
        • Yoshida M.
        Impact of acute hyperglycemia on left ventricular function after reperfusion therapy in patients with a first anterior wall acute myocardial infarction.
        Am Heart J. 2003; 146: 674-678
        • Esposito K.
        • Nappo F.
        • Marfella R.
        • Giugliano G.
        • Giugliano F.
        • Ciotola M.
        • Quagliaro L.
        • Ceriello A.
        • Giugliano D.
        Inflammatory cytokine concentrations are acutely increased by hyperglycemia in humans: role of oxidative stress.
        Circulation. 2002; 106: 2067-2072
        • Monnier L.
        • Mas E.
        • Ginet C.
        • Michel F.
        • Villon L.
        • Cristol J.P.
        • Colette C.
        Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes.
        JAMA. 2006; 295: 1681-1687
        • Feuvray D.
        • Lopaschuk G.D.
        Controversies on the sensitivity of the diabetic heart to ischemic injury: the sensitivity of the diabetic heart to ischemic injury is decreased.
        Cardiovasc Res. 1997; 34: 113-120
        • Desouza C.
        • Salazar H.
        • Cheong B.
        • Murgo J.
        • Fonseca V.
        Association of hypoglycaemia and cardiac ischaemia: a study based on continuous monitoring.
        Diabetes Care. 2003; 26: 1485-1489
        • Depre C.
        • Vanoverschelde J.L.J.
        • Taegtmeyer H.
        Glucose for the heart.
        Circulation. 1999; 99: 578-588
        • Kahn B.B.
        Facilitative glucose transporters: regulatory mechanisms and dysregulation in diabetes.
        J Clin Invest. 1992; 89: 1367-1374
        • Opie L.H.
        Metabolic perturbations in ischemic heart disease.
        Dialogues Cardiovasc Med. 1996; 2: 75-82
        • Malmberg K.
        • Rydén L.
        • Efendic S.
        • Herlitz J.
        • Nicol P.
        • Waldenström A.
        • Wedel H.
        • Welin L.
        • DIGAMI study group
        Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effect on mortality at 1 year.
        J Am Coll Cardiol. 1995; 26: 57-65
        • The CREATE-ECLA Trial Group
        Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction.
        JAMA. 2005; 293: 437-446
        • Mellbin L.G.
        • Malmberg K.
        • Norhammar A.
        • Wedel H.
        • Rydén L.
        • DIGAMI 2 Investigators
        The impact of glucose lowering treatment on long-term prognosis in patients with type 2 diabetes and myocardial infarction: a report from the DIGAMI 2 trial.
        Eur Heart J. 2008; 29: 166-176
        • Norhammar A.Tenerz Å
        • Nilsson G.
        • Hamsten A.
        • Efendíc S.
        • Rydén L.
        • Malmberg K.
        Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study.
        Lancet. 2002; 359: 2140-2144
        • Ishihara M.
        • Inoue I.
        • Kawagoe T.
        • Shimatani Y.
        • Kurisu S.
        • Hata T.
        • Nakama Y.
        • Kijima Y.
        • Kagawa E.
        Is admission hyperglycemia in non-diabetic patients with acute myocardial infarction a surrogate for previously undiagnosed abnormal glucose tolerance?.
        Eur Heart J. 2006; 27: 2413-2419