Key result
High admission glucose in STEMI linked to ~6-fold higher long-term mortality.
Why the study?
The presence of diabetes and admission plasma glucose concentration are associated with adverse outcomes after AMI, but the relationship with sFas apoptosis and long-term survival in STEMI patients was unclear.
Does high admission plasma glucose level increase mortality and sFas apoptosis levels in patients with acute STEMI?
Cohort (n=83)
No
Does high admission plasma glucose level increase mortality and sFas apoptosis levels in patients with acute STEMI?
Absolute Event Rate: 19.2% vs 3%
p-value: p=<0.05
High admission plasma glucose in STEMI patients is associated with increased sFas apoptosis levels and significantly higher long-term mortality.
Admission hyperglycemia was associated with higher STEMI mortality; hypothesis-generating for sFas mediation and requires prospective trials before practice change.
BACKGROUND: The presence of diabetes and plasma glucose concentration on admission are associated with adverse outcomes after an acute myocardial infarction (AMI), as high glucose can induce vascular endothelial cell apoptosis. This study explored the relative associations among admission plasma glucose level, soluble Fas (sFas) concentration, and long-term survival in patients with acute ST-elevation myocardial infarction (STEMI). METHODS: This prospective cohort study include 83 patients with acute STEMI. Based on their admission plasma glucose levels (7.8 and 11.1 mmol/L as the limits for low and high levels, respectively), patients were allocated into one of three groups: normal glucose (n = 33), median glucose (n = 24), and high glucose (n = 26). The admission plasma level of sFas was measured with a sandwich enzyme-linked immunosorbent assay (ELISA). Patients were followed up for an average of 89 ± 20 months for all causes of death and cardiovascular death. RESULTS: sFas levels were significantly higher in the high glucose group compared to the normal glucose group (5.87 ± 1.70 mmol/L vs. 3.07 ± 0.93 mmol/L, respectively, P < 0.05). The sFas level was positively associated with the admission plasma glucose level. The correlation coefficient (R) was 0.747, and R2 was 0.559. Mortality was significantly higher in the high glucose group compared to the normal glucose group (19.2% vs. 3.0%, respectively, P < 0.05). CONCLUSIONS: In patients with acute STEMI, plasma glucose level was high on admission, and sFas apoptosis levels were increased. Long-term follow-up revealed that a high admission plasma glucose level was associated with higher mortality compared to a normal admission glucose level.
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Chang et al. (2013) conducted a cohort in Acute ST-elevation myocardial infarction (STEMI) (n=83). High admission plasma glucose level (≥11.1 mmol/L) vs. Normal admission plasma glucose level (< 7.8 mmol/L) was evaluated on All-cause mortality (p=<0.05). High admission plasma glucose levels (≥11.1 mmol/L) in patients with acute STEMI were associated with significantly higher long-term mortality compared to normal glucose levels (19.2% vs. 3.0%, P<0.05).
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