Hyperglycemia during acute myocardial infarction in patients who are treated by primary percutaneous coronary intervention: Impact on long-term prognosis

Background: Transient hyperglycemia is common during acute myocardial infarction in non-diabetic patients and is associated with a worse outcome. There is limited data on the outcome of patients who undergo primary percutaneous coronary intervention and have transient hyperglycemia. Methods: Fasting plasma glucose was measured in 431 consecutive acute myocardial infarction patients who underwent primary percutaneous coronary interventions. Patients were classified into three groups: non-diabetics/non-hyperglycemic (NDNH, glucose<126 mg/ dL; n= 224); non-diabetics/hyperglycemic (NDH, glucose >= 126 mg/ dL; n= 119); and diabetics (n= 88). Data were analyzed according to the different groups and according to exact glucose levels. Results: In-hospital mortality was significantly lower in NDNH (1%) compared to NDH (8%) and diabetic (5%) patients (p = 0.01). One-year cumulative mortality was highest (10%) in patients with NDH (p<0.001). One year target lesion revascularization rates were identical in NDNH and NDH patients (6% vs. 8%) and higher in diabetic patients (19%, p = 0.001). In a multivariate model, a striking increase in the risk of death (0.6%, p= 0.05) and target lesion revascularization (2%, p<0.0001) was found for every increment of 1 mg/ dL in glucose level. Conclusions: Transient hyperglycemia in non-diabetic acute myocardial infarction patients who undergo primary percutaneous coronary interventions is associated with high one-year mortality. One year target lesion revascularization rates were significantly higher in diabetics compared to non-diabetics with normoglycemia or transient hyperglycemia. (c) 2007 Elsevier Ireland Ltd. All rights reserved.