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Does glucose level at hospital discharge predict one-year mortality in patients with diabetes mellitus treated with percutaneous coronary intervention for ST-segment elevation myocardial infarction?
Kardiol Pol. 2008 Jan; 66(1):1-8; discussion 9-11.KP

Abstract

BACKGROUND

It has been shown that diabetes mellitus (DM) is an independent prognostic factor in patients with myocardial infarction (MI). In addition to that fact the prognostic significance of blood glucose (BG) abnormalities in the acute phase of MI has also been suggested. Recently, a new prognostic factor has been evaluated - the glucose level at hospital discharge.

AIM

To assess whether the glucose level at hospital discharge is associated with one-year mortality in patients with DM treated with percutaneous coronary intervention (PCI) for ST-segment elevation MI (STEMI), taking into account hypoglycaemic treatment.

METHODS

Consecutive patients with STEMI and DM treated with PCI, who survived hospitalisation, were included in the analysis. Patients were assumed to have DM if previous diagnosis of DM or newly diagnosed DM during hospital stay was noted. Criteria of newly diagnosed DM were as follows: fasting BG >or=7 mmol/l at least twice after acute phase of STEMI, BG >or=11.1 mmol/l in a 2-hour glucose tolerance test performed before discharge. Fasting plasma glucose at hospital discharge was used for analysis.

RESULTS

Out of 2762 consecutive patients with STEMI, 565 had DM. In-hospital mortality in this group was 9.4% (53 patients), so the final DM group consisted of 512 patients. After discharge 59 (11.5%) patients died during one-year follow-up. The glucose level at discharge was not an independent prognostic factor of one-year mortality in the whole analysed group, however insulin treatment at discharge was (HR 2.61, 95% CI 1.29-5.29; p=0.008). Afterwards, we undertook multivariate analysis separately in the group treated with insulin (253 patients) and in the group treated with oral drugs or diet only (259 patients). This analysis showed that in the group treated with insulin the glucose level at discharge was not an independent prognostic factor of one-year mortality (HR 1.07, 95% CI 0.95-1.22; p=0.27), whereas in patients treated with hypoglycaemic agents or diet it was significantly associated with a one-year mortality (HR 1.30, 95% CI 1.01-1.68; p=0.049).

CONCLUSIONS

1. Patients with STEMI and DM treated with insulin at hospital discharge have higher risk of death, probably because of more advanced DM and more severe complications, than patients treated with oral drugs or diet. 2. Elevated glucose level at hospital discharge predict one-year mortality only in patients with MI and DM treated with oral drugs or diet.

Authors+Show Affiliations

III Katedra i Oddział Kliniczny Kardiologii SUM, Slaskie Centrum Chorób Serca, ul. Szpitalna 2, 41-800 Zabrze. mariuszgasior@poczta.onet.plNo 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

18266182

Citation

Gasior, Mariusz, et al. "Does Glucose Level at Hospital Discharge Predict One-year Mortality in Patients With Diabetes Mellitus Treated With Percutaneous Coronary Intervention for ST-segment Elevation Myocardial Infarction?" Kardiologia Polska, vol. 66, no. 1, 2008, pp. 1-8; discussion 9-11.
Gasior M, Pres D, Stasik-Pres G, et al. Does glucose level at hospital discharge predict one-year mortality in patients with diabetes mellitus treated with percutaneous coronary intervention for ST-segment elevation myocardial infarction? Kardiol Pol. 2008;66(1):1-8; discussion 9-11.
Gasior, M., Pres, D., Stasik-Pres, G., Lech, P., Gierlotka, M., Lekston, A., Hawranek, M., Tajstra, M., Kalarus, Z., & Poloński, L. (2008). Does glucose level at hospital discharge predict one-year mortality in patients with diabetes mellitus treated with percutaneous coronary intervention for ST-segment elevation myocardial infarction? Kardiologia Polska, 66(1), 1-8; discussion 9-11.
Gasior M, et al. Does Glucose Level at Hospital Discharge Predict One-year Mortality in Patients With Diabetes Mellitus Treated With Percutaneous Coronary Intervention for ST-segment Elevation Myocardial Infarction. Kardiol Pol. 2008;66(1):1-8; discussion 9-11. PubMed PMID: 18266182.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does glucose level at hospital discharge predict one-year mortality in patients with diabetes mellitus treated with percutaneous coronary intervention for ST-segment elevation myocardial infarction? AU - Gasior,Mariusz, AU - Pres,Damian, AU - Stasik-Pres,Gabriela, AU - Lech,Piotr, AU - Gierlotka,Marek, AU - Lekston,Andrzej, AU - Hawranek,Michał, AU - Tajstra,Mateusz, AU - Kalarus,Zbigniew, AU - Poloński,Lech, PY - 2008/2/13/pubmed PY - 2008/5/28/medline PY - 2008/2/13/entrez SP - 1-8; discussion 9-11 JF - Kardiologia polska JO - Kardiol Pol VL - 66 IS - 1 N2 - BACKGROUND: It has been shown that diabetes mellitus (DM) is an independent prognostic factor in patients with myocardial infarction (MI). In addition to that fact the prognostic significance of blood glucose (BG) abnormalities in the acute phase of MI has also been suggested. Recently, a new prognostic factor has been evaluated - the glucose level at hospital discharge. AIM: To assess whether the glucose level at hospital discharge is associated with one-year mortality in patients with DM treated with percutaneous coronary intervention (PCI) for ST-segment elevation MI (STEMI), taking into account hypoglycaemic treatment. METHODS: Consecutive patients with STEMI and DM treated with PCI, who survived hospitalisation, were included in the analysis. Patients were assumed to have DM if previous diagnosis of DM or newly diagnosed DM during hospital stay was noted. Criteria of newly diagnosed DM were as follows: fasting BG >or=7 mmol/l at least twice after acute phase of STEMI, BG >or=11.1 mmol/l in a 2-hour glucose tolerance test performed before discharge. Fasting plasma glucose at hospital discharge was used for analysis. RESULTS: Out of 2762 consecutive patients with STEMI, 565 had DM. In-hospital mortality in this group was 9.4% (53 patients), so the final DM group consisted of 512 patients. After discharge 59 (11.5%) patients died during one-year follow-up. The glucose level at discharge was not an independent prognostic factor of one-year mortality in the whole analysed group, however insulin treatment at discharge was (HR 2.61, 95% CI 1.29-5.29; p=0.008). Afterwards, we undertook multivariate analysis separately in the group treated with insulin (253 patients) and in the group treated with oral drugs or diet only (259 patients). This analysis showed that in the group treated with insulin the glucose level at discharge was not an independent prognostic factor of one-year mortality (HR 1.07, 95% CI 0.95-1.22; p=0.27), whereas in patients treated with hypoglycaemic agents or diet it was significantly associated with a one-year mortality (HR 1.30, 95% CI 1.01-1.68; p=0.049). CONCLUSIONS: 1. Patients with STEMI and DM treated with insulin at hospital discharge have higher risk of death, probably because of more advanced DM and more severe complications, than patients treated with oral drugs or diet. 2. Elevated glucose level at hospital discharge predict one-year mortality only in patients with MI and DM treated with oral drugs or diet. SN - 0022-9032 UR - https://www.unboundmedicine.com/medline/citation/18266182/Does_glucose_level_at_hospital_discharge_predict_one_year_mortality_in_patients_with_diabetes_mellitus_treated_with_percutaneous_coronary_intervention_for_ST_segment_elevation_myocardial_infarction L2 - http://www.diseaseinfosearch.org/result/2236 DB - PRIME DP - Unbound Medicine ER -