October 12, 2012Circulation Cardiovascular Imaging
Prognostic Impact of Hyperglycemia in Nondiabetic and Diabetic Patients With ST-Elevation Myocardial Infarction
Key result
Pre-existing diabetes mellitus in STEMI patients was associated with a higher risk of major adverse cardiovascular events compared to nondiabetic patients (32% vs 11%; P<0.001).
Why the study?
Does hyperglycemia on admission increase the risk of major adverse cardiovascular events and myocardial damage in STEMI patients with and without diabetes?
Population
411 consecutive STEMI patients reperfused by primary angioplasty
Comparison
Hyperglycemia on admission vs Normoglycemia on admission
Design
Cohort
Follow-up
long-term
Authors
Discussion
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Member takes
Implication
Admission hyperglycemia signals greater injury and events in STEMI, stronger in nondiabetics; supports targeted glycemic studies but should not yet change practice.
Key Points
- This research aims to analyze the effects of hyperglycemia and diabetes on myocardial damage and long-term outcomes in STEMI patients.
- Glucose levels assessed in 411 STEMI patients after primary angioplasty.
- Magnetic resonance imaging conducted to evaluate infarct size and microvascular obstruction.
- Primary clinical endpoint involved major adverse cardiovascular events during long-term follow-up.
- Patients with diabetes experienced major adverse cardiovascular events at a rate of 32% compared to 11% in nondiabetic patients (P<0.001).
- Higher admission glucose correlated with increased myocardial damage in nondiabetic patients (threshold >7.8 mmol/L).
- No significant differences in infarct size between diabetic and nondiabetic groups despite differing mortality rates.
Study Design
Type
Cohort (n=411)
Structured PICO
Does hyperglycemia on admission increase the risk of major adverse cardiovascular events and myocardial damage in STEMI patients with and without diabetes?
P
Population
411 consecutive STEMI patients reperfused by primary angioplasty, evaluated for the impact of admission hyperglycemia and diabetes status on long-term outcomes.
E
Exposure
Hyperglycemia on admission
C
Comparator
Normoglycemia on admission
O
Outcome
Occurrence of major adverse cardiovascular events at long-term follow-upcomposite
Main Result
Absolute Event Rate: 32% vs 11%
p-value: p=<0.001
Hyperglycemia on admission in STEMI patients is associated with greater myocardial injury and long-term MACE, with a lower glucose threshold for harm in nondiabetic compared to diabetic patients.
Cite This Study
Eitel et al. (2012) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=411). Pre-existing diabetes mellitus and admission hyperglycemia vs. Nondiabetic patients and normoglycemia was evaluated on occurrence of major adverse cardiovascular events at long-term follow-up (p=<0.001). Pre-existing diabetes mellitus in STEMI patients was associated with a higher risk of major adverse cardiovascular events compared to nondiabetic patients (32% vs 11%; P<0.001).