Lower mean postadmission glucose levels were associated with better survival in AMI patients regardless of insulin therapy (OR 2.1; 95% CI 1.3-3.5 for 110-<140 vs <110 mg/dL).
Cohort (n=7,820)
Yes
Does glucose normalization after admission, either spontaneous or via insulin therapy, improve survival in hyperglycemic patients with acute myocardial infarction?
Glucose normalization after admission in hyperglycemic patients with acute myocardial infarction is associated with improved survival, regardless of whether normoglycemia is achieved spontaneously or via insulin therapy.
Effect estimate: OR 2.1 (95% CI 1.3-3.5)
BACKGROUND: Elevated blood glucose levels on admission are associated with increased mortality in patients with acute myocardial infarction. Whether glucose normalization after admission is associated with improved survival remains controversial. In addition, whether outcomes differ in patients who have spontaneous resolution of hyperglycemia vs those who achieve normoglycemia after treatment with insulin is also unknown. METHODS: We studied 7820 hyperglycemic (admission glucose level, > or =140 mg/dL to convert glucose to millimoles per liter, multiply by 0.0555) patients with acute myocardial infarction hospitalized between January 1, 2000, and December 31, 2005, in 40 US hospitals. Patients were stratified according to their mean glucose levels after admission and were divided into those who did and did not receive insulin therapy. Multivariable logistic regression models were developed to examine whether lower glucose levels after admission are independently associated with better survival. Propensity-matching methods were then used to compare in-hospital mortality in patients who did and did not receive insulin therapy. RESULTS: After multivariable adjustment, lower mean postadmission glucose levels were associated with better survival (for mean postadmission glucose levels of 110 to or =200 mg/dL, the odds ratios 95% confidence intervals were 2.1 1.3-3.5, 5.3 3.0-8.6, 6.9 4.1-11.4, and 13.0 8.0-21.3, respectively, vs <110 mg/dL). Similar results were seen in patients who did and did not receive insulin therapy (P =.74 for insulin therapy x postadmission glucose level interaction). In propensity-matched analysis, mortality rates were similar between insulin-treated and non-insulin-treated patients across the spectrum of mean postadmission glucose levels (range, P = .15 to P = .91). CONCLUSIONS: Glucose normalization after admission is associated with better survival in hyperglycemic patients hospitalized with acute myocardial infarction whether or not they receive insulin therapy. A strategy of intentional glucose lowering with insulin therapy needs to be further tested in future randomized controlled trials.
Kosiborod et al. (2009) conducted a cohort in Acute myocardial infarction with hyperglycemia (n=7,820). Glucose normalization (lower mean postadmission glucose levels) vs. Higher mean postadmission glucose levels was evaluated on In-hospital mortality (OR 2.1, 95% CI 1.3-3.5). Lower mean postadmission glucose levels were associated with better survival in AMI patients regardless of insulin therapy (OR 2.1; 95% CI 1.3-3.5 for 110-<140 vs <110 mg/dL).