Amr Abdin1, Janine Pöss1,2, Georg Fuernau1,2, Taoufik Ouarrak3, Steffen Desch4, Ingo Eitel1,2, Suzanne de Waha1,2, Uwe Zeymer5, Michael Böhm6, Holger Thiele7. 1. Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Centre Luebeck, Luebeck, Germany. 2. German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Luebeck, Germany. 3. Institut für Herzinfarktforschung, Ludwigshafen, Germany. 4. Department of Internal Medicine/Cardiology, University of Leipzig-Heart Centre Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany. 5. Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany. 6. Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany. 7. Department of Internal Medicine/Cardiology, University of Leipzig-Heart Centre Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany. holger.thiele@medizin.uni-leipzig.de.
Abstract
BACKGROUND: Limited data from observational retrospective studies suggest an association between glucose levels and prognosis of patients with cardiogenic shock (CS). The aim of this study was to investigate the prognostic role of glucose at admission in patients with acute myocardial infarction (AMI) complicated by CS included in the largest CS trial to date, the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial. METHODS AND RESULTS: In the IABP-SHOCK II-trial, patients with CS complicating AMI undergoing early revascularization were randomized to a therapy with vs. without IABP support. Primary and secondary endpoints were mortality within 30 days and 1 year, respectively. Glucose levels were examined at admission. Glucose levels were available in 513 patients. In total, 33.7% of the patients had known diabetes. Patients with diabetes had higher glucose levels compared to those without diabetes (median [interquartile range (IQR)] 13.1 mmol/L [IQR 9.5-18.3] vs. 10.8 mmol/L [IQR 7.8-15.4], p = 0.0003). Patients with glucose concentrations above the median (11.5 mmol/L) had higher 30-day and 1-year mortality compared to those below the median (47.7 vs. 36.5%, p = 0.004; 57.7 vs. 47.1%, p = 0.011, respectively). This negative prognostic impact of increased glucose levels remained significant in multivariate adjustment and was not influenced even after adjustment for the presence or absence of diabetes mellitus. CONCLUSIONS: In patients with CS complicating AMI, increased glucose concentration at admission was an independent predictor for mortality at 30-days and 1-year, independently of the diabetic state.
RCT Entities:
BACKGROUND: Limited data from observational retrospective studies suggest an association between glucose levels and prognosis of patients with cardiogenic shock (CS). The aim of this study was to investigate the prognostic role of glucose at admission in patients with acute myocardial infarction (AMI) complicated by CS included in the largest CS trial to date, the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial. METHODS AND RESULTS: In the IABP-SHOCK II-trial, patients with CS complicating AMI undergoing early revascularization were randomized to a therapy with vs. without IABP support. Primary and secondary endpoints were mortality within 30 days and 1 year, respectively. Glucose levels were examined at admission. Glucose levels were available in 513 patients. In total, 33.7% of the patients had known diabetes. Patients with diabetes had higher glucose levels compared to those without diabetes (median [interquartile range (IQR)] 13.1 mmol/L [IQR 9.5-18.3] vs. 10.8 mmol/L [IQR 7.8-15.4], p = 0.0003). Patients with glucose concentrations above the median (11.5 mmol/L) had higher 30-day and 1-year mortality compared to those below the median (47.7 vs. 36.5%, p = 0.004; 57.7 vs. 47.1%, p = 0.011, respectively). This negative prognostic impact of increased glucose levels remained significant in multivariate adjustment and was not influenced even after adjustment for the presence or absence of diabetes mellitus. CONCLUSIONS: In patients with CS complicating AMI, increased glucose concentration at admission was an independent predictor for mortality at 30-days and 1-year, independently of the diabetic state.
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