Different values of glycemia at admission and fasting predict mortality in acute myocardial infarction

Argentine Registry of Acute Infarction SAC-FAC

Abstract

Introduction: Hyperglycemia is associated with adverse evolution in ST-elevation myocardial infarction (STEMI). Objectives: To evaluate the prognostic value of blood sugar level at admission and fasting to identify the in-hospital risk of STEMI. Material and methods: The ARGEN-IAM-ST was a prospective, observational registry, conducted on 247 Argentine centers, including patients with STEMI, between March and December/2015. From the total, 1254 cases were included in this analysis with determinations of glycemia on admission and fasting. Results: The average age of the population was 66.2±13.4 years, 22% were women. Eighty-six
percent received reperfusion strategy. Overall in-hospital mortality in the Registry was 8.8%. The area under the ROC curve for mortality prediction for glycemia at admission (GluAd) and fasting (GluFas) was 0.66 and 0.67, and the population was divided by the lowest value (1) or greater (2) of the median of 136 and 110 mg/dl, respectively. The mortality related to these cutoff points with respect to GlyAd-1 vs GlyAd-2 was 3.7 vs 11.3% (p <0.0001), and GlyFas-1 vs GlyFas-2 was 2.8 vs 7.1% (p=0.001). According to the admission and discharge values, they were classified into 4 groups: A) Normal glycemia at baseline and fasting, B) Low basal and high fasting, 3) High basal and low fasting and 4) Always high, mortality being 2; 3.5; 4.2 and 8.7%, respectively (p <0.0001). Multiple logistic regression analysis (including GlyAd, GlyFas, gender, age, sinus rhythm on admission, anterior infarction, diabetes, smoking, systolic and diastolic pressure on admission, heart rate, creatinine and heart failure): variables significantly associated with in-hospital mortality were GlyAd>136 mg/dl (OR: 2.148, 95% CI 1.051-4.388, p=0.01); age (OR 1.073, 95% CI 1.044-1.102, p=0.002) and heart failure (OR 20, 95% CI 7.700-51.985, p<0.001). Conclusions: Glycemia is a strong predictor of hospital mortality due to infarction. The risk-related values are different between admission (>136 mg/dl) and fasting (>110 mg/dl). However, blood glucose determination at STEMI admission represents the best high-risk metabolic indicator.