Which is worst in patients undergoing primary angioplasty for acute myocardial infarction? Hyperglycaemia? Diabetes mellitus? Or both?

Abstract

Objective— The objective of this study was to evaluate the effect of admission hyperglycaemia and/or diabetes mellitus (DM) on the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).

Methods— 2482 consecutive patients with STEMI (mean age 56.5 ± 11.9, years, 2064 men) undergoing primary PCI between October 2003 and March 2008 were retrospectively enrolled into the present study. Hyperglycaemia was defined as a venous plasma glucose level > 200 mg/dl on admission. Patients were classified into four groups: non-diabetic/non-hyperglycaemic (NDNH, n = 1806) patients; diabetic/non-hyperglycaemic (DNH, n = 271) patients; non-diabetic/hyperglycaemic (NDH, n = 64); and diabetic/hyperglycaemic (DH, n = 341).

Results— In-hospital mortality was higher in NDH (12.5%) compared to DH (8.5%), DNH (6.3%), and NDNH (0.9%) patients (P < 0.001). The composite end points including death, reinfarction, and target-vessel revascularization (major adverse cardiac events [MACE]) in the hospital were also higher in NDH (18.8%) compared with other patients (DH, 13.8% vs. DNH, 10.3% vs. NDNH, 3.7%, P < 0.001).The median follow-up time was 21 months.The Kaplan-Meier survival plot for long-term cardiovascular death was worst for DH patients (log rank P < 0.001).After adjustment for potentially confounding factors, NDH (OR 3.04, 95% CI 1.06-8.73; P = 0.03), and DH (OR 2.3, 95% CI 1.29-4.09; P = 0.005), but not DNH (OR 1.22, 95% CI 0.57-2.6; P = 0.6) status, remained independent predictors of long-term cardiovascular mortality.

Conclusions — STEMI patients with NDH represent the highest risk population for in-hospital mortality, and MACE.The worst outcomes for long-term cardiovascular mortality occur in DH patients.

• Primary angioplasty
• acute myocardial infarction
• hyperglycaemia
• diabetes mellitus
• prognosis