Eun Jung Kim1, Myung Ho Jeong2, Ju Han Kim1, Tae Hoon Ahn3, Ki Bae Seung4, Dong Joo Oh5, Hyo-Soo Kim6, Hyeon Cheol Gwon7, In Whan Seong8, Kyung Kuk Hwang9, Shung Chull Chae10, Kwon-Bae Kim11, Young Jo Kim12, Kwang Soo Cha13, Seok Kyu Oh14, Jei Keon Chae15. 1. Chonnam National University Hospital, Gwangju, Republic of Korea. 2. Chonnam National University Hospital, Gwangju, Republic of Korea. Electronic address: myungho@chollian.net. 3. Gachon University Gil Medical Center, Incheon, Republic of Korea. 4. The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Republic of Korea. 5. Korea University Guro Hospital, Seoul, Republic of Korea. 6. Seoul National University Hospital, Seoul, Republic of Korea. 7. Sungkyunkwan Universtiy Samsung Medical Center, Seoul, Republic of Korea. 8. Chungnam National University Hospital, Daejeon, Republic of Korea. 9. Chungbuk National University Hospital, Cheongju, Republic of Korea. 10. Kyungpook National University Hospital, Daegu, Republic of Korea. 11. Keimyung University Dongsan Medical Center, Daegu, Republic of Korea. 12. Yeungnam University Hospital, Daegu, Republic of Korea. 13. Pusan National University Hospital, Busan, Republic of Korea. 14. Wonkwang University Hospital, Iksan, Republic of Korea. 15. Chonbuk National University Hospital, Jeonju, Republic of Korea.
Abstract
BACKGROUND: Acute hyperglycemia on admission is common in acute myocardial infarction (AMI) patients regardless of diabetic status, and is known as one of prognostic factors. However, the effect of hyperglycemia on non-diabetic patients is still on debate. METHODS: A total of 12,625 AMI patients (64.0±12.6years, 26.1% female) who were enrolled in Korea Acute Myocardial Infarction Registry-National Institute of Health between November 2011 and December 2015, were classified into 4367 diabetes (65.4±11.6years, 30.4% female) and 8228 non-diabetes (63.3±13years, 23.9% female). Patients were analyzed for in-hospital clinical outcome according to admission hyperglycemic status. RESULTS: In diabetic patients, independent predictors of in-hospital mortality were old age, high HbA1C, pre-Thrombolysis In Myocardial Infarction (TIMI) flow 0, left ventricle ejection fraction<40%, cardiogenic shock and ventricular tachycardia. In non-diabetic patients, independent predictors of in-hospital mortality were old age, high admission glucose (≥200mg/dL), pre TIMI flow 0, failed percutaneous coronary intervention, low left ventricle ejection fraction<40%, cardiogenic shock, stent thrombosis and decreased Hb≥5g/dL. In hospital mortality was significantly higher in diabetic patients compared to non-diabetic patients (5.0% vs. 3.4%, p<0.001). However, non-diabetic patients with hyperglycemia have significantly higher mortality compared to diabetic patients (17.4% vs. 7.2%, p<0.001). Comorbidity including cardiogenic shock (p<0.001), cerebral hemorrhage (p=0.012), decreased Hb≥5g/dL (p=0.013), atrioventricular block (p<0.001) and ventricular tachycardia (p=0.007) was higher in non-diabetic with hyperglycemia than in diabetic patients. CONCLUSIONS: These findings underscore clinical significance of admission hyperglycemia on in-hospital mortality in non-diabetic AMI patients.
BACKGROUND: Acute hyperglycemia on admission is common in acute myocardial infarction (AMI) patients regardless of diabetic status, and is known as one of prognostic factors. However, the effect of hyperglycemia on non-diabeticpatients is still on debate. METHODS: A total of 12,625 AMI patients (64.0±12.6years, 26.1% female) who were enrolled in Korea Acute Myocardial Infarction Registry-National Institute of Health between November 2011 and December 2015, were classified into 4367 diabetes (65.4±11.6years, 30.4% female) and 8228 non-diabetes (63.3±13years, 23.9% female). Patients were analyzed for in-hospital clinical outcome according to admission hyperglycemic status. RESULTS: In diabeticpatients, independent predictors of in-hospital mortality were old age, high HbA1C, pre-Thrombolysis In Myocardial Infarction (TIMI) flow 0, left ventricle ejection fraction<40%, cardiogenic shock and ventricular tachycardia. In non-diabeticpatients, independent predictors of in-hospital mortality were old age, high admission glucose (≥200mg/dL), pre TIMI flow 0, failed percutaneous coronary intervention, low left ventricle ejection fraction<40%, cardiogenic shock, stent thrombosis and decreased Hb≥5g/dL. In hospital mortality was significantly higher in diabeticpatients compared to non-diabeticpatients (5.0% vs. 3.4%, p<0.001). However, non-diabeticpatients with hyperglycemia have significantly higher mortality compared to diabeticpatients (17.4% vs. 7.2%, p<0.001). Comorbidity including cardiogenic shock (p<0.001), cerebral hemorrhage (p=0.012), decreased Hb≥5g/dL (p=0.013), atrioventricular block (p<0.001) and ventricular tachycardia (p=0.007) was higher in non-diabetic with hyperglycemia than in diabeticpatients. CONCLUSIONS: These findings underscore clinical significance of admission hyperglycemia on in-hospital mortality in non-diabetic AMIpatients.
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Authors: Hae Young Yang; Min Joo Ahn; Myung Ho Jeong; Youngkeun Ahn; Young Jo Kim; Myeong Chan Cho; Chong Jin Kim Journal: Chonnam Med J Date: 2019-01-25
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