Key result
An ultra-acute increase in blood glucose during the prehospital phase was significantly higher in STEMI patients who died within 30 days compared to survivors (+1.2 vs -0.3 mmol/l, P=0.03).
Why the study?
Does an ultra-acute increase in blood glucose during the prehospital phase predict worse survival in adult patients with STEMI?
Observational (n=152)
No
Does an ultra-acute increase in blood glucose during the prehospital phase predict worse survival in adult patients with STEMI?
An ultra-acute increase in blood glucose during the prehospital phase in STEMI patients is associated with increased 30-day mortality, impaired cardiac function, and worse 3-year survival.
Ultra-acute prehospital glucose rise was associated with 30-day mortality in STEMI; hypothesis-generating and should not yet change practice.
BACKGROUND: The current study was to investigate the blood glucose changes in ultra-acute phase in patients with ST-elevation myocardial infarction (STEMI) and its associations with patient outcome. METHODS: This study was a retrospective population-based observational study utilizing prospectively collected registry data complemented with laboratory data. All adult patients with STEMI treated by emergency medical services (EMS) in the city of Helsinki from January 2006 to December 2010 were included in the study. Both prehospital and hospital admission glucose values were available from 152 (32%) of all STEMI patients (n = 469). RESULTS: Change in blood glucose from prehospital phase to emergency department admission was significantly higher in non-survivors within 30 days compared to survivors (+1.2 ± 5.1 vs. -0.3 ± 2.4 mmol/l [mean ± SD], P = 0.03). Furthermore, the 3-year survival rate was significantly lower in patients with an evident (≥2 mmol/l) rise in blood glucose (P = 0.02). In patients with impaired left ventricle function (best ejection fraction < 40%), blood glucose increased more compared to patients without it (1.2 ± 2.9 vs. 0.4 ± 2.7 mmol/l, P = 0.01). Increase in glucose was correlated with peak myocardial creatinine kinase (r = 0.17, P = 0.04) as a marker of increased size of infarct, but not with glycosylated haemoglobin A1C as a marker of chronic hyperglycaemia (r = -0.12, P = 0.27). CONCLUSIONS: In patients with STEMI, ultra-acute hyperglycaemia during prehospital phase is associated with increased mortality, impaired cardiac function and increased size of infarct.
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Vihonen et al. (2014) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=152). Ultra-acute increase in blood glucose during prehospital phase vs. No increase or smaller increase in blood glucose was evaluated on 30-day survival (p=0.03). An ultra-acute increase in blood glucose during the prehospital phase was significantly higher in STEMI patients who died within 30 days compared to survivors (+1.2 vs -0.3 mmol/l, P=0.03).
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