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Postprocedural hyperglycemia in ST elevation myocardial infarction submitted to percutaneous coronary intervention: a prognostic indicator and a marker of metabolic derangement.

Abstract

BACKGROUND

Hyperglycemia in acute coronary syndrome is associated with an increased risk of death in patients without previously known diabetes but the prognostic role of postrevascularization hyperglycemia in these patients is so far incompletely elucidated.

MATERIALS AND METHODS

In 175 consecutive patients without previously known diabetes and with ST elevation myocardial infarction treated with primary angioplasty, we evaluated the relation between acute and chronic glucose dysmetabolism and early and late mortality and the relation between hyperglycemia and extension of myocardial damage [creatine phosphokinase-MB (CPK-MB), troponin I levels, ejection fraction], inflammation (leukocyte count, erythrocyte sedimentation rate, C-reactive protein) and prognostic biohumoral markers [N-terminal brain natriuretic peptide (NT-proBNP) and lactic acid].

RESULTS

Highest glucose levels were associated with higher Killip class, lower ejection fraction and increased values of CPK, CPK-MB, troponin I, proBNP, lactic acid, leukocytes and insulin. At multivariate logistic regression analysis, the following variables were independent predictors of intraintensive cardiac care unit mortality: postprocedural glycemia [odds ratio (OR) 8.79; 95% confidence interval (CI) 1.41-54.94; P = 0.020] and troponin I (OR 1.003; 95% CI 1.0004-1.006; P = 0.023) when adjusted for insulinemia [OR 0.98; 95% CI 0.92-1.06; P = not significant (NS)], HbA1c (OR 0.51; 95% CI 0.11-2.37; P = NS), ST elevation myocardial infarction location (OR 1.27; 95% CI 0.44-3.66; P = NS) and creatininemia (OR 1.48; 95% CI 0.90-2.45; P = NS).

CONCLUSION

In ST elevation myocardial infarction patients without previously known diabetes submitted to percutaneous coronary intervention, glucose serum levels measured after mechanical revascularization were independent predictors of in-hospital mortality.

Authors+Show Affiliations

Department of Heart and Vessel Disease, Intensive Cardiac Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. lazzeric@libero.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19829142

Citation

Lazzeri, Chiara, et al. "Postprocedural Hyperglycemia in ST Elevation Myocardial Infarction Submitted to Percutaneous Coronary Intervention: a Prognostic Indicator and a Marker of Metabolic Derangement." Journal of Cardiovascular Medicine (Hagerstown, Md.), vol. 11, no. 1, 2010, pp. 7-13.
Lazzeri C, Chiostri M, Sori A, et al. Postprocedural hyperglycemia in ST elevation myocardial infarction submitted to percutaneous coronary intervention: a prognostic indicator and a marker of metabolic derangement. J Cardiovasc Med (Hagerstown). 2010;11(1):7-13.
Lazzeri, C., Chiostri, M., Sori, A., Valente, S., & Gensini, G. F. (2010). Postprocedural hyperglycemia in ST elevation myocardial infarction submitted to percutaneous coronary intervention: a prognostic indicator and a marker of metabolic derangement. Journal of Cardiovascular Medicine (Hagerstown, Md.), 11(1), pp. 7-13. doi:10.2459/JCM.0b013e32832d83b3.
Lazzeri C, et al. Postprocedural Hyperglycemia in ST Elevation Myocardial Infarction Submitted to Percutaneous Coronary Intervention: a Prognostic Indicator and a Marker of Metabolic Derangement. J Cardiovasc Med (Hagerstown). 2010;11(1):7-13. PubMed PMID: 19829142.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Postprocedural hyperglycemia in ST elevation myocardial infarction submitted to percutaneous coronary intervention: a prognostic indicator and a marker of metabolic derangement. AU - Lazzeri,Chiara, AU - Chiostri,Marco, AU - Sori,Andrea, AU - Valente,Serafina, AU - Gensini,Gian Franco, PY - 2009/10/16/entrez PY - 2009/10/16/pubmed PY - 2010/1/29/medline SP - 7 EP - 13 JF - Journal of cardiovascular medicine (Hagerstown, Md.) JO - J Cardiovasc Med (Hagerstown) VL - 11 IS - 1 N2 - BACKGROUND: Hyperglycemia in acute coronary syndrome is associated with an increased risk of death in patients without previously known diabetes but the prognostic role of postrevascularization hyperglycemia in these patients is so far incompletely elucidated. MATERIALS AND METHODS: In 175 consecutive patients without previously known diabetes and with ST elevation myocardial infarction treated with primary angioplasty, we evaluated the relation between acute and chronic glucose dysmetabolism and early and late mortality and the relation between hyperglycemia and extension of myocardial damage [creatine phosphokinase-MB (CPK-MB), troponin I levels, ejection fraction], inflammation (leukocyte count, erythrocyte sedimentation rate, C-reactive protein) and prognostic biohumoral markers [N-terminal brain natriuretic peptide (NT-proBNP) and lactic acid]. RESULTS: Highest glucose levels were associated with higher Killip class, lower ejection fraction and increased values of CPK, CPK-MB, troponin I, proBNP, lactic acid, leukocytes and insulin. At multivariate logistic regression analysis, the following variables were independent predictors of intraintensive cardiac care unit mortality: postprocedural glycemia [odds ratio (OR) 8.79; 95% confidence interval (CI) 1.41-54.94; P = 0.020] and troponin I (OR 1.003; 95% CI 1.0004-1.006; P = 0.023) when adjusted for insulinemia [OR 0.98; 95% CI 0.92-1.06; P = not significant (NS)], HbA1c (OR 0.51; 95% CI 0.11-2.37; P = NS), ST elevation myocardial infarction location (OR 1.27; 95% CI 0.44-3.66; P = NS) and creatininemia (OR 1.48; 95% CI 0.90-2.45; P = NS). CONCLUSION: In ST elevation myocardial infarction patients without previously known diabetes submitted to percutaneous coronary intervention, glucose serum levels measured after mechanical revascularization were independent predictors of in-hospital mortality. SN - 1558-2035 UR - https://www.unboundmedicine.com/medline/citation/19829142/Postprocedural_hyperglycemia_in_ST_elevation_myocardial_infarction_submitted_to_percutaneous_coronary_intervention:_a_prognostic_indicator_and_a_marker_of_metabolic_derangement_ L2 - http://Insights.ovid.com/pubmed?pmid=19829142 DB - PRIME DP - Unbound Medicine ER -