The prognostic role of in-hospital peak glycemia in stemi patients with and without diabetes.

Due to the lack of appropriately designed randomized trials, the definitive answer in regard to the prognostic role of in-hospital glucose values in patients with AMI is lacking. We prospectively assessed the prognostic role of in-hospital peak glycemia (≤1.40, 141-180 and >180 g/l) in 611 consecutive STEMI patients (diabetic and without previously known diabetes) submitted to percutaneous coronary intervention. One hundred and fifteen (18.8%) were diabetic and the remaining 496 (81.2%) without previously known diabetes. At multivariable logistic regression analysis, peak glycemia was an independent predictor for in-ICCU death in the overall population and in patients without previously known diabetes. At follow-up, in the overall population (as well as in diabetic and non-diabetic patients), patients with peak glycemia >1.8 g/l showed the lowest survival rate, those with peak glycemia <1.4 g/l the highest and patients with peak glycemia >1.4 and <1.8 g/l intermediate survival rates. In-hospital peak glycemia is an independent predictor for early death in patients without previously known diabetes, but not in diabetic STEMI patients. At follow-up, in-hospital peak glycemia is able to affect long-term survival in diabetic and non-diabetic patients. Our data underscore strongly suggest that different glucose targets and thresholds may be pursued in diabetic and non-diabetic STEMI patients.