Department of Cardiology, Medical University in Bialystok, ul. M. Skłodowskiej-Curie 24A, Białystok, Poland.
Kardiol Pol. 2012;70(6):564-72.
Stress hyperglycaemia on admission is a predictor of mortality in patients with acute myocardial infarction (MI).
To establish what level of hyperglycaemia on admission indicates a significantly poorer long-term prognosis in patients with MI treated invasively.
Glycaemia on admission was measured in patients with both ST-segment elevation MI (STEMI) and non-ST- -segment elevation MI (NSTEMI) treated with percutaneous coronary intervention (PCI). In-hospital and late mortality were evaluated during a 679.3 ± 202 day follow-up.
We enrolled 794 patients (564 men; 71%), mean age 63.8 ± 11.3 years. One per cent of the patients died during initial hospitalisation, and 10% during the two-year follow-up. The mean value of glycaemia in the whole population was 115 ± 36 mg/dL (6.32 ± 1.98 mmol/L). Admission glycaemia in patients who died in hospital was 194 ± 71 mg/dL (10.67 ± 3.91 mmol/L), while in the patients discharged home it was 114 ± 35 mg/dL (6.27 ± 1.93 mmol/L) (p 〈 0.0001). In terms of two-year mortality, the patients who died had also significantly higher glycaemia on admission (145 ± 48 mg/dL; 7.98 ± 2.64 mmol/L) vs 112 ± 31 mg/dL (6.16 ± 1.71 mmol/L, p 〈 0.0001). Apart from admission hyperglycaemia, we found the following risk factors of late mortality in univariate analysis: age, heart rate (HR), left ventricular ejection fraction (LVEF), glomerular filtration rate (GFR), creatinine level, number of significantly narrowed coronary vessels other than the infarct related artery (IRA), and unsuccessful PCI. In multivariate analysis, the following parameters correlated with death in the two-year follow-up: glycaemia on admission, age, HR, LVEF, GFR, creatinine level, total cholesterol, number of significantly narrowed coronary vessels other than the IRA, and unsuccessful PCI. Hyperglycaemia on admission was an independent risk factor of death even after adjustment for confounding variables such as age, sex and LVEF. We compared the areas under ROC curve for in-hospital mortality and the areas under ROC curve for late mortality according to glycaemia on admission. Both were significantly different from those of a random model (p 〈 0.001 and p 〈 0.001, respectively). A glycaemia value of 205 mg/dL (11.28 mmol/L) calculated from ROC curve had the highest sensitivity and specificity for late mortality. Apart from these findings, we observed a linear correlation between glycaemia and mortality.
The best cut-off value for stress hyperglycaemia determined by ROC curve in patients with acute MI treated invasively is 205 mg/dL (11.28 mmol/L). Patients with glucose levels 〉 205 mg/dL (11.28 mmol/L) on admission have significantly higher late mortality compared to those with glucose levels 〈 205 mg/dL (11.28 mmol/L). Our results suggest that hyperglycaemia is a reliable marker of poor outcome in acute MI patients with and without previously diagnosed diabetes mellitus. This level of glucose may be used in risk stratification in patients with acute MI.
入院时的应激性高血糖是急性心肌梗死（MI）患者死亡的预测指标。
确定在接受经皮冠状动脉介入治疗（PCI）的 MI 患者中，入院时的何种程度的高血糖表明预后明显较差。
测量接受经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）和非 ST 段抬高型心肌梗死（NSTEMI）患者入院时的血糖水平。在 679.3 ± 202 天的随访期间评估院内和晚期死亡率。
我们共纳入 794 例患者（564 例男性；71%），平均年龄为 63.8 ± 11.3 岁。1%的患者在住院期间死亡，10%的患者在两年随访期间死亡。整个人群的血糖平均值为 115 ± 36 mg/dL（6.32 ± 1.98 mmol/L）。住院期间死亡患者的入院血糖为 194 ± 71 mg/dL（10.67 ± 3.91 mmol/L），而出院回家的患者为 114 ± 35 mg/dL（6.27 ± 1.93 mmol/L）（p 〈 0.0001）。就两年死亡率而言，死亡患者的入院血糖也明显更高（145 ± 48 mg/dL；7.98 ± 2.64 mmol/L）与 112 ± 31 mg/dL（6.16 ± 1.71 mmol/L，p 〈 0.0001）。除入院高血糖外，我们还发现单因素分析中晚期死亡率的以下危险因素：年龄、心率（HR）、左心室射血分数（LVEF）、肾小球滤过率（GFR）、肌酐水平、梗死相关动脉（IRA）以外狭窄程度显著的冠状动脉数量以及 PCI 不成功。在多因素分析中，以下参数与两年随访期间的死亡相关：入院时的血糖、年龄、HR、LVEF、GFR、肌酐水平、总胆固醇、IRA 以外狭窄程度显著的冠状动脉数量以及 PCI 不成功。入院时的高血糖即使在调整年龄、性别和 LVEF 等混杂因素后，也是死亡的独立危险因素。我们根据入院时的血糖比较了住院死亡率和晚期死亡率的 ROC 曲线下面积。两者均明显不同于随机模型（p 〈 0.001 和 p 〈 0.001）。根据 ROC 曲线计算的 205 mg/dL（11.28 mmol/L）的血糖值对于晚期死亡率具有最高的敏感性和特异性。除了这些发现，我们还观察到血糖与死亡率之间存在线性相关性。
在接受侵袭性治疗的急性 MI 患者中，ROC 曲线确定的应激性高血糖最佳截断值为 205 mg/dL（11.28 mmol/L）。入院时血糖水平〉205 mg/dL（11.28 mmol/L）的患者与血糖水平〈205 mg/dL（11.28 mmol/L）的患者相比，晚期死亡率明显更高。我们的结果表明，高血糖是伴有或不伴有先前诊断为糖尿病的急性 MI 患者预后不良的可靠标志物。该血糖水平可用于急性 MI 患者的风险分层。
