Dysglycemia on admission is known to predict the prognosis of ST-segment elevation
myocardial infarction (STEMI). Recently, hypoxic liver injury (HLI) has been proposed
as a novel prognosticator for STEMI. We evaluated the prognostic impact of combined
dysglycemia and HLI at the time of presentation in patients with STEMI who underwent
primary percutaneous coronary intervention. From 2007 to 2014, 1,525 consecutive patients
(79% men, mean age 61 years) who underwent primary percutaneous coronary intervention
for STEMI in the INTERSTELLAR (Incheon-Bucheon Cohort of Patients Undergoing Primary
PCI for Acute ST-Elevation Myocardial Infarction) cohort were analyzed retrospectively.
Dysglycemia was defined as either hypoglycemia (serum glucose <90 mg/dl) or hyperglycemia
(serum glucose >250 mg/dl). HLI was defined as more than twofold increase of any serum
aminotransferases above the upper normal limit. Patients were divided into 4 groups
according to their dysglycemia and HLI status on admission: group 1, normoglycemia
without HLI; group 2, dysglycemia without HLI; group 3, normoglycemia with HLI; and
group 4, dysglycemia with HLI. Primary end point was inhospital death and secondary
end point was all-cause mortality at 12 months after the index procedure. Of the 1,525
patients, there were 87 inhospital deaths (5.7%) and 113 all-cause deaths (7.4%) at
12 months after the index procedure. Both dysglycemia and HLI on admission were independent
predictors of inhospital death. Inhospital mortality rate was the highest in group
4 (32.1%), followed by groups 2 and 3. Kaplan-Meier survival analysis at 12 months
showed similar trends among the 4 groups. In conclusion, combined dysglycemia and
HLI on admission predicts early prognosis for STEMI.
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 accessOne-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 CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Clinical outcomes with drug-eluting and bare-metal stents in patients with ST-segment elevation myocardial infarction: evidence from a comprehensive network meta-analysis.J Am Coll Cardiol. 2013; 62: 496-504
- TIMI risk score for ST-elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation: an intravenous nPA for treatment of infarcting myocardium early II trial substudy.Circulation. 2000; 102: 2031-2037
- Predictors of hospital mortality in the global registry of acute coronary events.Arch Intern Med. 2013; 163: 2345-2353
- Clinical potential of insulin therapy in critically ill patients.Drugs. 2003; 63: 625-636
- 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2013; 61: e78-e140
- Glucometrics in patients hospitalized with acute myocardial infarction: defining the optimal outcomes-based measure of risk.Circulation. 2008; 117: 1018-1027
- Serum glutamic oxaloacetic transaminase activity in human acute transmural myocardial infarction.Science. 1954; 120: 497-499
- Serum transaminase determined in the emergency room predicts outcomes in patients with acute ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention.Int J Cardiol. 2014; 177: 442-447
- Quantitative angiographic methods for appropriate end-point analysis, edge-effect evaluation, and prediction of recurrent restenosis after coronary brachytherapy with gamma irradiation.J Am Coll Cardiol. 2002; 39: 274-280
- Inflammatory cytokine concentrations are acutely increased by hyperglycemia in humans: role of oxidative stress.Circulation. 2002; 106: 2067-2072
- Acute hyperglycemia attenuates endothelium-dependent vasodilation in human in vivo.Circulation. 1998; 97: 1695-1701
- Hyperglycemia stimulates coagulation, whereas hyperinsulinemia impairs fibrinolysis in healthy humans.Diabetes. 2006; 55: 1807-1812
- 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
- Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes.Circulation. 2005; 111: 3078-3086
- The prognostic value of blood glucose in diabetic patients with acute myocardial infarction.Diabet Med. 1996; 13: 80-83
- Determinants and importance of stress hyperglycaemia in non-diabetic patients with myocardial infarction.Br Med J. 1986; 293: 917-922
- Association between admission hypoglycaemia and in-hospital and 3-year mortality in older patients with acute myocardial infarction.Heart. 2010; 96: 1444-1450
- Risk of cardiac arrhythmias during hypoglycemia in patients with type 2 diabetes and cardiovascular risk.Diabetes. 2014; 63: 1738-1747
- Serum lactic dehydrogenase activity in acute transmural myocardial infarction.Science. 1956; 123: 1122-1123
- Specificity of serum creatine kinase isoenzymes in diagnosis of acute myocardial infarction.Br Med J. 1973; 1: 386-389
- Cardiac-specific troponin-I radioimmunoassay in the diagnosis of acute myocardial infarction.Am Heart J. 1987; 113: 1333-1344
- Pattern of liver enzyme elevations in acute ST-elevation myocardial infarction.Coron Artery Dis. 2012; 23: 22-30
- Prognostic impact of combined contrast-induced acute kidney injury and hypoxic liver injury in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention: results from INTERSTELLAR registry.PLos One. 2016; 11: e0159416
- Liver abnormalities in cardiac disease and heart failure.Int J Angiol. 2011; 20: 135-142
- Hepatic injury and gluconeogenesis after subcutaneous injection of monochloroacetic acid in rats.Environ Health Prev Med. 2004; 9: 58-62
- Acute hyperglycemia worsens hepatic ischemia/reperfusion injury in rats.J Gastrointest Surg. 2010; 14: 528-535
- Diagnosis of relative adrenal insufficiency in critically ill patients.Lancet. 1999; 354: 774-775
- A prospective study on the incidence and predictive factors of relative adrenal insufficiency in Korean critically-ill patients.J Korean Med Sci. 2009; 24: 668-673
- STEMI and NSTEMI: are they so different? 1 year outcomes in acute myocardial infarction as defined by the ESC/ACC definition (the OPERA registry).Eur Heart J. 2007; 28: 1409-1417
Article info
Publication history
Published online: January 25, 2017
Accepted:
January 3,
2017
Received in revised form:
January 3,
2017
Received:
September 23,
2016
Footnotes
Drs Jang, Kwon, Kim (TH) and Oh contributed equally to this work.
See page 1184 for disclosure information.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
