Prognostic Value of Admission Glycosylated Hemoglobin and Glucose in Nondiabetic Patients With ST-Segment–Elevation Myocardial Infarction Treated With Percutaneous Coronary Intervention
In nondiabetic patients with ST-segment-elevation myocardial infarction, acute hyperglycemia is associated with adverse outcome. Whether this association is due merely to hyperglycemia as an acute stress response or whether longer-term glycometabolic derangements are also involved is uncertain. It w...
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| Published in | Circulation (New York, N.Y.) Vol. 124; no. 6; pp. 704 - 711 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Hagerstown, MD
Lippincott Williams & Wilkins
09.08.2011
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-7322 1524-4539 1524-4539 |
| DOI | 10.1161/CIRCULATIONAHA.110.985911 |
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| Abstract | In nondiabetic patients with ST-segment-elevation myocardial infarction, acute hyperglycemia is associated with adverse outcome. Whether this association is due merely to hyperglycemia as an acute stress response or whether longer-term glycometabolic derangements are also involved is uncertain. It was our aim to determine the association between both acute and chronic hyperglycemia (hemoglobin A(₁c) [HbA(₁c)]) and outcome in nondiabetic patients with ST-segment-elevation myocardial infarction.
This observational study included consecutive patients (n=4176) without known diabetes mellitus admitted with ST-segment-elevation myocardial infarction. All patients were treated with primary percutaneous intervention. Both glucose and HbA(1c) were measured on admission. Main outcome measure was total long-term mortality; secondary outcome measures were 1-year mortality and enzymatic infarct size. One-year mortality was 4.7%, and mortality after total follow-up (3.3 ± 1.5 years) was 10%. Both elevated HbA(1c) levels (P<0.001) and elevated admission glucose (P<0.001) were associated with 1-year and long-term mortality. After exclusion of early mortality (within 30 days), HbA(₁c) remained associated with long-term mortality (P<0.001), whereas glucose lost significance (P=0.09). Elevated glucose, but not elevated HbA(₁c), was associated with larger infarct size. After multivariate analysis, HbA(₁c) (hazard ratio, 1.2 per interquartile range; P<0.01), but not glucose, was independently associated with long-term mortality.
In nondiabetic patients with ST-segment-elevation myocardial infarction, both elevated admission glucose and HbA(₁c) levels were associated with adverse outcome. Both of these parameters reflect different patient populations, and their association with outcome is probably due to different mechanisms. Measurement of both parameters enables identification of these high-risk groups for aggressive secondary risk prevention. |
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| AbstractList | In nondiabetic patients with ST-segment-elevation myocardial infarction, acute hyperglycemia is associated with adverse outcome. Whether this association is due merely to hyperglycemia as an acute stress response or whether longer-term glycometabolic derangements are also involved is uncertain. It was our aim to determine the association between both acute and chronic hyperglycemia (hemoglobin A(₁c) [HbA(₁c)]) and outcome in nondiabetic patients with ST-segment-elevation myocardial infarction.
This observational study included consecutive patients (n=4176) without known diabetes mellitus admitted with ST-segment-elevation myocardial infarction. All patients were treated with primary percutaneous intervention. Both glucose and HbA(1c) were measured on admission. Main outcome measure was total long-term mortality; secondary outcome measures were 1-year mortality and enzymatic infarct size. One-year mortality was 4.7%, and mortality after total follow-up (3.3 ± 1.5 years) was 10%. Both elevated HbA(1c) levels (P<0.001) and elevated admission glucose (P<0.001) were associated with 1-year and long-term mortality. After exclusion of early mortality (within 30 days), HbA(₁c) remained associated with long-term mortality (P<0.001), whereas glucose lost significance (P=0.09). Elevated glucose, but not elevated HbA(₁c), was associated with larger infarct size. After multivariate analysis, HbA(₁c) (hazard ratio, 1.2 per interquartile range; P<0.01), but not glucose, was independently associated with long-term mortality.
In nondiabetic patients with ST-segment-elevation myocardial infarction, both elevated admission glucose and HbA(₁c) levels were associated with adverse outcome. Both of these parameters reflect different patient populations, and their association with outcome is probably due to different mechanisms. Measurement of both parameters enables identification of these high-risk groups for aggressive secondary risk prevention. In nondiabetic patients with ST-segment-elevation myocardial infarction, acute hyperglycemia is associated with adverse outcome. Whether this association is due merely to hyperglycemia as an acute stress response or whether longer-term glycometabolic derangements are also involved is uncertain. It was our aim to determine the association between both acute and chronic hyperglycemia (hemoglobin A(₁c) [HbA(₁c)]) and outcome in nondiabetic patients with ST-segment-elevation myocardial infarction.BACKGROUNDIn nondiabetic patients with ST-segment-elevation myocardial infarction, acute hyperglycemia is associated with adverse outcome. Whether this association is due merely to hyperglycemia as an acute stress response or whether longer-term glycometabolic derangements are also involved is uncertain. It was our aim to determine the association between both acute and chronic hyperglycemia (hemoglobin A(₁c) [HbA(₁c)]) and outcome in nondiabetic patients with ST-segment-elevation myocardial infarction.This observational study included consecutive patients (n=4176) without known diabetes mellitus admitted with ST-segment-elevation myocardial infarction. All patients were treated with primary percutaneous intervention. Both glucose and HbA(1c) were measured on admission. Main outcome measure was total long-term mortality; secondary outcome measures were 1-year mortality and enzymatic infarct size. One-year mortality was 4.7%, and mortality after total follow-up (3.3 ± 1.5 years) was 10%. Both elevated HbA(1c) levels (P<0.001) and elevated admission glucose (P<0.001) were associated with 1-year and long-term mortality. After exclusion of early mortality (within 30 days), HbA(₁c) remained associated with long-term mortality (P<0.001), whereas glucose lost significance (P=0.09). Elevated glucose, but not elevated HbA(₁c), was associated with larger infarct size. After multivariate analysis, HbA(₁c) (hazard ratio, 1.2 per interquartile range; P<0.01), but not glucose, was independently associated with long-term mortality.METHODS AND RESULTSThis observational study included consecutive patients (n=4176) without known diabetes mellitus admitted with ST-segment-elevation myocardial infarction. All patients were treated with primary percutaneous intervention. Both glucose and HbA(1c) were measured on admission. Main outcome measure was total long-term mortality; secondary outcome measures were 1-year mortality and enzymatic infarct size. One-year mortality was 4.7%, and mortality after total follow-up (3.3 ± 1.5 years) was 10%. Both elevated HbA(1c) levels (P<0.001) and elevated admission glucose (P<0.001) were associated with 1-year and long-term mortality. After exclusion of early mortality (within 30 days), HbA(₁c) remained associated with long-term mortality (P<0.001), whereas glucose lost significance (P=0.09). Elevated glucose, but not elevated HbA(₁c), was associated with larger infarct size. After multivariate analysis, HbA(₁c) (hazard ratio, 1.2 per interquartile range; P<0.01), but not glucose, was independently associated with long-term mortality.In nondiabetic patients with ST-segment-elevation myocardial infarction, both elevated admission glucose and HbA(₁c) levels were associated with adverse outcome. Both of these parameters reflect different patient populations, and their association with outcome is probably due to different mechanisms. Measurement of both parameters enables identification of these high-risk groups for aggressive secondary risk prevention.CONCLUSIONSIn nondiabetic patients with ST-segment-elevation myocardial infarction, both elevated admission glucose and HbA(₁c) levels were associated with adverse outcome. Both of these parameters reflect different patient populations, and their association with outcome is probably due to different mechanisms. Measurement of both parameters enables identification of these high-risk groups for aggressive secondary risk prevention. |
| Author | Bilo, Henk J.G. Nijsten, Maarten W.N. Ottervanger, Jan Paul Zijlstra, Felix van der Horst, Iwan C.C. Slingerland, Robbert J. Dambrink, Jan-Henk E. Timmer, Jorik R. Hoekstra, Miriam van 't Hof, Arnoud W.J. |
| Author_xml | – sequence: 1 givenname: Jorik R. surname: Timmer fullname: Timmer, Jorik R. organization: From the Departments of Cardiology (J.R.T., J.P.O., J.-H.E.D., A.W.J.v.H.), Clinical Chemistry (R.J.S.), and Internal Medicine (H.J.G.B.), Isala Klinieken, Zwolle, the Netherlands, and Departments of Anesthesiology (M.H.), Cardiology (M.H., I.C.C.v.d.H., F.Z.), Critical Care (M.W.N.N.), and Internal Medicine (H.J.G.B.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands – sequence: 2 givenname: Miriam surname: Hoekstra fullname: Hoekstra, Miriam organization: From the Departments of Cardiology (J.R.T., J.P.O., J.-H.E.D., A.W.J.v.H.), Clinical Chemistry (R.J.S.), and Internal Medicine (H.J.G.B.), Isala Klinieken, Zwolle, the Netherlands, and Departments of Anesthesiology (M.H.), Cardiology (M.H., I.C.C.v.d.H., F.Z.), Critical Care (M.W.N.N.), and Internal Medicine (H.J.G.B.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands – sequence: 3 givenname: Maarten W.N. surname: Nijsten fullname: Nijsten, Maarten W.N. organization: From the Departments of Cardiology (J.R.T., J.P.O., J.-H.E.D., A.W.J.v.H.), Clinical Chemistry (R.J.S.), and Internal Medicine (H.J.G.B.), Isala Klinieken, Zwolle, the Netherlands, and Departments of Anesthesiology (M.H.), Cardiology (M.H., I.C.C.v.d.H., F.Z.), Critical Care (M.W.N.N.), and Internal Medicine (H.J.G.B.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands – sequence: 4 givenname: Iwan C.C. surname: van der Horst fullname: van der Horst, Iwan C.C. organization: From the Departments of Cardiology (J.R.T., J.P.O., J.-H.E.D., A.W.J.v.H.), Clinical Chemistry (R.J.S.), and Internal Medicine (H.J.G.B.), Isala Klinieken, Zwolle, the Netherlands, and Departments of Anesthesiology (M.H.), Cardiology (M.H., I.C.C.v.d.H., F.Z.), Critical Care (M.W.N.N.), and Internal Medicine (H.J.G.B.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands – sequence: 5 givenname: Jan Paul surname: Ottervanger fullname: Ottervanger, Jan Paul organization: From the Departments of Cardiology (J.R.T., J.P.O., J.-H.E.D., A.W.J.v.H.), Clinical Chemistry (R.J.S.), and Internal Medicine (H.J.G.B.), Isala Klinieken, Zwolle, the Netherlands, and Departments of Anesthesiology (M.H.), Cardiology (M.H., I.C.C.v.d.H., F.Z.), Critical Care (M.W.N.N.), and Internal Medicine (H.J.G.B.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands – sequence: 6 givenname: Robbert J. surname: Slingerland fullname: Slingerland, Robbert J. organization: From the Departments of Cardiology (J.R.T., J.P.O., J.-H.E.D., A.W.J.v.H.), Clinical Chemistry (R.J.S.), and Internal Medicine (H.J.G.B.), Isala Klinieken, Zwolle, the Netherlands, and Departments of Anesthesiology (M.H.), Cardiology (M.H., I.C.C.v.d.H., F.Z.), Critical Care (M.W.N.N.), and Internal Medicine (H.J.G.B.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands – sequence: 7 givenname: Jan-Henk E. surname: Dambrink fullname: Dambrink, Jan-Henk E. organization: From the Departments of Cardiology (J.R.T., J.P.O., J.-H.E.D., A.W.J.v.H.), Clinical Chemistry (R.J.S.), and Internal Medicine (H.J.G.B.), Isala Klinieken, Zwolle, the Netherlands, and Departments of Anesthesiology (M.H.), Cardiology (M.H., I.C.C.v.d.H., F.Z.), Critical Care (M.W.N.N.), and Internal Medicine (H.J.G.B.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands – sequence: 8 givenname: Henk J.G. surname: Bilo fullname: Bilo, Henk J.G. organization: From the Departments of Cardiology (J.R.T., J.P.O., J.-H.E.D., A.W.J.v.H.), Clinical Chemistry (R.J.S.), and Internal Medicine (H.J.G.B.), Isala Klinieken, Zwolle, the Netherlands, and Departments of Anesthesiology (M.H.), Cardiology (M.H., I.C.C.v.d.H., F.Z.), Critical Care (M.W.N.N.), and Internal Medicine (H.J.G.B.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands – sequence: 9 givenname: Felix surname: Zijlstra fullname: Zijlstra, Felix organization: From the Departments of Cardiology (J.R.T., J.P.O., J.-H.E.D., A.W.J.v.H.), Clinical Chemistry (R.J.S.), and Internal Medicine (H.J.G.B.), Isala Klinieken, Zwolle, the Netherlands, and Departments of Anesthesiology (M.H.), Cardiology (M.H., I.C.C.v.d.H., F.Z.), Critical Care (M.W.N.N.), and Internal Medicine (H.J.G.B.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands – sequence: 10 givenname: Arnoud W.J. surname: van 't Hof fullname: van 't Hof, Arnoud W.J. organization: From the Departments of Cardiology (J.R.T., J.P.O., J.-H.E.D., A.W.J.v.H.), Clinical Chemistry (R.J.S.), and Internal Medicine (H.J.G.B.), Isala Klinieken, Zwolle, the Netherlands, and Departments of Anesthesiology (M.H.), Cardiology (M.H., I.C.C.v.d.H., F.Z.), Critical Care (M.W.N.N.), and Internal Medicine (H.J.G.B.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands |
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| Copyright | 2015 INIST-CNRS |
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| Keywords | Human Myocardial infarction Prognosis Cardiovascular disease Glucose hemoglobin A Coronary heart disease Myocardial disease Percutaneous route ST elevation Treatment glycosylated Hemoglobin |
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| Snippet | In nondiabetic patients with ST-segment-elevation myocardial infarction, acute hyperglycemia is associated with adverse outcome. Whether this association is... |
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| SubjectTerms | Adult Angioplasty, Balloon, Coronary Anticoagulants - therapeutic use Biological and medical sciences Biomarkers Blood and lymphatic vessels Blood Glucose - analysis Cardiology. Vascular system Combined Modality Therapy Coronary heart disease Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - diagnosis Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Electrocardiography Female Follow-Up Studies Glucose Metabolism Disorders - blood Glucose Metabolism Disorders - complications Glycated Hemoglobin A - analysis Heart Humans Hyperglycemia - blood Kaplan-Meier Estimate Male Medical sciences Middle Aged Myocardial Infarction - blood Myocardial Infarction - drug therapy Myocardial Infarction - mortality Myocardial Infarction - pathology Myocardial Infarction - therapy Netherlands - epidemiology Patient Admission Prognosis Proportional Hazards Models |
| Title | Prognostic Value of Admission Glycosylated Hemoglobin and Glucose in Nondiabetic Patients With ST-Segment–Elevation Myocardial Infarction Treated With Percutaneous Coronary Intervention |
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