Glucose dysregulation in nondiabetic patients with ST-elevation myocardial infarction: acute and chronic glucose dysregulation in STEMI

Background: Admission hyperglycaemia is associated with an increased risk of mortality after myocardial infarction. Whether long-term glucose dysregulation (assessed by HbAic) is more important than acute hyperglycaemia is unknown. We evaluated the prognostic value of admission glucose and HbAic levels in nondiabetic patients with ST-segment elevation acute myocardial infarction (STEMI). Methods: In 504 unselected, consecutive patients with STEMI, glucose and HbAic levels were measured on admission. Glucose was categorised as = 11.1 mmol/l (n=82). HbAic levels were categorised as = 6.0% (n=88). Mean follow-up was 1.6 +/- 0.6 years. Results: Patients with hyperglycaemia on admission were comparable with those with normoglycaernia. However, patients with HbAic >= 6.0%, as compared with those with HbAic = 11.1 mmol/l) was 4% and 19% (p= 6%) was 5% and 12% (p=0.03)After multivariable analyses, admission glucose (OR 4.91, 95% CI 2.03 to 11.9, p<0.001) but not HbAic (OR 1.33, 95% CI 0.48 to 3.71, p=0.58) was significantly associated with 30-day mortality. Among 30-day survivors, neither admission glucose nor HbAic were predictors of long-term mortality. Conclusion: Elevated admission glucose is an important predictor of 30-day outcome after STEMI, while prior long-term glucose dysregulation is a covariate of other high-risk clinical characteristics. Among 30-day survivors, neither admission blood glucose nor HbAic were predictors of long-term outcome.