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In patients with ST-segment elevation myocardial infarction with cardiogenic shock treated with percutaneous coronary intervention, admission glucose level is a strong independent predictor for 1-year mortality in patients without a prior diagnosis of diabetes.
Am Heart J. 2007 Dec; 154(6):1184-90.AH

Abstract

BACKGROUND

Primary percutaneous coronary intervention (PCI) reduces mortality in patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). Despite PCI, mortality in CS is still approximately 50%. Admission glucose concentration is an independent predictor of mortality in patients with STEMI and is associated with the occurrence of CS. Whether admission glucose is also a predictor of mortality in CS patients treated with primary PCI is unexplored. We therefore assessed the relation between admission glucose concentration and 1-year mortality in patients with STEMI with CS without a prior diagnosis of diabetes on admission and treated with PCI.

METHODS

We investigated a cohort of 208 consecutive patients with STEMI without a prior diagnosis of diabetes with CS on admission. Patients were classified according to glucose levels at admission: <7.8 mmol/L (group 1, n = 57), 7.8 to 11 mmol/L (group 2, n = 71), and >11.0 mmol/L (group 3, n = 80).

RESULTS

The overall 1-year mortality was 38%. One-year mortality was 21%, 27%, and 60% in groups I, II, and III, respectively (P < .001). In a multivariate logistic regression analysis, the odds for mortality increased by 16% for every 1 mmol/L increase in plasma glucose concentration (OR 1.155, 95% CI 1.070-1.247), after adjustment for left ventricular ejection fraction <40%, age older than 75 years, male sex, and thrombolysis in myocardial infarction 3 flow after PCI.

CONCLUSIONS

In patients with STEMI with CS and without a prior diagnosis of diabetes undergoing primary PCI, admission glucose concentration is a very strong independent predictor for 1-year mortality. Further studies are warranted to determine whether concomitant glycometabolic regulation in patients with STEMI treated with PCI, particularly those with CS, will improve clinical outcome.

Authors+Show Affiliations

Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18035093

Citation

Vis, Marije M., et al. "In Patients With ST-segment Elevation Myocardial Infarction With Cardiogenic Shock Treated With Percutaneous Coronary Intervention, Admission Glucose Level Is a Strong Independent Predictor for 1-year Mortality in Patients Without a Prior Diagnosis of Diabetes." American Heart Journal, vol. 154, no. 6, 2007, pp. 1184-90.
Vis MM, Sjauw KD, van der Schaaf RJ, et al. In patients with ST-segment elevation myocardial infarction with cardiogenic shock treated with percutaneous coronary intervention, admission glucose level is a strong independent predictor for 1-year mortality in patients without a prior diagnosis of diabetes. Am Heart J. 2007;154(6):1184-90.
Vis, M. M., Sjauw, K. D., van der Schaaf, R. J., Baan, J., Koch, K. T., DeVries, J. H., Tijssen, J. G., de Winter, R. J., Piek, J. J., & Henriques, J. P. (2007). In patients with ST-segment elevation myocardial infarction with cardiogenic shock treated with percutaneous coronary intervention, admission glucose level is a strong independent predictor for 1-year mortality in patients without a prior diagnosis of diabetes. American Heart Journal, 154(6), 1184-90.
Vis MM, et al. In Patients With ST-segment Elevation Myocardial Infarction With Cardiogenic Shock Treated With Percutaneous Coronary Intervention, Admission Glucose Level Is a Strong Independent Predictor for 1-year Mortality in Patients Without a Prior Diagnosis of Diabetes. Am Heart J. 2007;154(6):1184-90. PubMed PMID: 18035093.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - In patients with ST-segment elevation myocardial infarction with cardiogenic shock treated with percutaneous coronary intervention, admission glucose level is a strong independent predictor for 1-year mortality in patients without a prior diagnosis of diabetes. AU - Vis,Marije M, AU - Sjauw,Krischan D, AU - van der Schaaf,René J, AU - Baan,Jan,Jr AU - Koch,Karel T, AU - DeVries,J Hans, AU - Tijssen,Jan G P, AU - de Winter,Robbert J, AU - Piek,Jan J, AU - Henriques,José P S, Y1 - 2007/09/12/ PY - 2007/02/05/received PY - 2007/07/23/accepted PY - 2007/11/24/pubmed PY - 2007/12/6/medline PY - 2007/11/24/entrez SP - 1184 EP - 90 JF - American heart journal JO - Am. Heart J. VL - 154 IS - 6 N2 - BACKGROUND: Primary percutaneous coronary intervention (PCI) reduces mortality in patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). Despite PCI, mortality in CS is still approximately 50%. Admission glucose concentration is an independent predictor of mortality in patients with STEMI and is associated with the occurrence of CS. Whether admission glucose is also a predictor of mortality in CS patients treated with primary PCI is unexplored. We therefore assessed the relation between admission glucose concentration and 1-year mortality in patients with STEMI with CS without a prior diagnosis of diabetes on admission and treated with PCI. METHODS: We investigated a cohort of 208 consecutive patients with STEMI without a prior diagnosis of diabetes with CS on admission. Patients were classified according to glucose levels at admission: <7.8 mmol/L (group 1, n = 57), 7.8 to 11 mmol/L (group 2, n = 71), and >11.0 mmol/L (group 3, n = 80). RESULTS: The overall 1-year mortality was 38%. One-year mortality was 21%, 27%, and 60% in groups I, II, and III, respectively (P < .001). In a multivariate logistic regression analysis, the odds for mortality increased by 16% for every 1 mmol/L increase in plasma glucose concentration (OR 1.155, 95% CI 1.070-1.247), after adjustment for left ventricular ejection fraction <40%, age older than 75 years, male sex, and thrombolysis in myocardial infarction 3 flow after PCI. CONCLUSIONS: In patients with STEMI with CS and without a prior diagnosis of diabetes undergoing primary PCI, admission glucose concentration is a very strong independent predictor for 1-year mortality. Further studies are warranted to determine whether concomitant glycometabolic regulation in patients with STEMI treated with PCI, particularly those with CS, will improve clinical outcome. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/18035093/In_patients_with_ST_segment_elevation_myocardial_infarction_with_cardiogenic_shock_treated_with_percutaneous_coronary_intervention_admission_glucose_level_is_a_strong_independent_predictor_for_1_year_mortality_in_patients_without_a_prior_diagnosis_of_diabetes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(07)00611-4 DB - PRIME DP - Unbound Medicine ER -