This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (57)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in this journal  Topic Collections  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic

Ischa Stranders, MD; Michaela Diamant, MD, PhD; Rogier E. van Gelder, MD; Hugo J. Spruijt, MSEE; Jos W. R. Twisk, PhD; Robert J. Heine, MD, PhD, FRCP; Frans C. Visser, MD, PhD

Arch Intern Med. 2004;164:982-988.

Background  High admission blood glucose levels after acute myocardial infarction (AMI) are common and associated with an increased risk of death in subjects with and without known diabetes. Recent data indicate a high prevalence of abnormal glucose metabolism in patients with unknown diabetes at the time of AMI. We investigated the predictive value of admission blood glucose levels after AMI for long-term prognosis in patients with and without previously diagnosed diabetes mellitus, particularly in those with unknown diabetes but with blood glucose levels in the diabetic range.

Methods  In a retrospective study with prospective follow-up, 846 patients (737 without and 109 with known diabetes) were eligible for follow-up during a median of 50 months (range, 0-93 months).

Results  During follow-up, 208 nondiabetic patients (28.2%) and 47 diabetic patients (43.1%) died (P = .002). An increase of 18 mg/dL (1 mmol/L) in glucose level was associated with a 4% increase of mortality risk in nondiabetic patients and 5% in diabetic patients (both P<.05). Of the 737 previously nondiabetic subjects, 101 had admission blood glucose levels of 200 mg/dL (11.1 mmol/L) or more, and mortality in these patients was comparable to that in patients who had established diabetes (42.6% vs 43.1%).

Conclusions  Admission blood glucose level after AMI is an independent predictor of long-term mortality in patients with and without known diabetes. Subjects with unknown diabetes and admission glucose levels of 200 mg/dL (11.1 mmol/L) or more after AMI have mortality rates comparable to those of subjects with established diabetes. Admission blood glucose level may serve to identify subjects at high long-term mortality risk, in particular among those with unknown diabetes.

From the Departments of Cardiology (Drs Stranders, and Visser and Mr Spruijt) and Endocrinology (Drs Diamant and Heine) and the Institute for Research in Extramural Medicine (Dr Twisk), VU University Medical Center, Amsterdam, the Netherlands; and Department of Radiology, Academic Medical Center, University of Amsterdam (Dr van Gelder). The authors have no relevant financial interest in this article.

RELATED LETTER

Blood Glucose Level as a Risk Indicator of Death After Acute Myocardial Infarction
Ravi K. Bobba and Edward L. Arsura
Arch Intern Med. 2004;164(22):2500.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Determinants of thrombin generation, fibrinolytic activity, and endothelial dysfunction in patients on dual antiplatelet therapy: involvement of factors other than platelet aggregability in Virchow's triad
Yano et al.
Eur Heart J 2008;29:1729-1738.
ABSTRACT | FULL TEXT  

Glucose-Insulin-Potassium for Acute Myocardial Infarction: Continuing Controversy Over Cardioprotection
Kloner and Nesto
Circulation 2008;117:2523-2533.
FULL TEXT  

Hyperglycemia and Acute Coronary Syndrome: A Scientific Statement From the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism
Deedwania et al.
Circulation 2008;117:1610-1619.
ABSTRACT | FULL TEXT  

Glucometrics in Patients Hospitalized With Acute Myocardial Infarction: Defining the Optimal Outcomes-Based Measure of Risk
Kosiborod et al.
Circulation 2008;117:1018-1027.
ABSTRACT | FULL TEXT  

Early impact of insulin treatment on mortality for hyperglycaemic patients without known diabetes who present with an acute coronary syndrome
Weston et al.
Heart 2007;93:1542-1546.
ABSTRACT | FULL TEXT  

Hyperglycaemia and mortality
Asadollahi et al.
JRSM 2007;100:503-507.
ABSTRACT | FULL TEXT  

Cellular recruitment and cytokine generation in a rat model of allergic lung inflammation are differentially modulated by progesterone and estradiol
de Oliveira et al.
Am. J. Physiol. Cell Physiol. 2007;293:C1120-C1128.
ABSTRACT | FULL TEXT  

Implications and Treatment of Acute Hyperglycemia in the Setting of Acute Myocardial Infarction
Zarich and Nesto
Circulation 2007;115:e436-e439.
FULL TEXT  

Synergistic relationship between hyperglycaemia and inflammation with respect to clinical outcomes in non-ST-elevation acute coronary syndromes: analyses from OPUS-TIMI 16 and TACTICS-TIMI 18
Ray et al.
Eur Heart J 2007;0:ehm010v1-8.
ABSTRACT | FULL TEXT  

Rush University Guidelines and Protocols for the Management of Hyperglycemia in Hospitalized Patients: Elimination of the Sliding Scale and Improvement of Glycemic Control Throughout the Hospital
Donaldson et al.
The Diabetes Educator 2006;32:954-962.
ABSTRACT | FULL TEXT  

Is admission hyperglycaemia in non-diabetic patients with acute myocardial infarction a surrogate for previously undiagnosed abnormal glucose tolerance?
Ishihara et al.
Eur Heart J 2006;27:2413-2419.
ABSTRACT | FULL TEXT  

Glucose and haemoglobin in the assessment of prognosis after first hospitalisation for heart failure
Newton and Squire
Heart 2006;92:1441-1446.
ABSTRACT | FULL TEXT  

Acute insulin resistance in myocardial ischemia: causes and consequences.
Smit and Romijn
SEMIN CARDIOTHORAC VASC ANESTH 2006;10:215-219.
ABSTRACT  

Admission Blood Glucose Level and Mortality Among Hospitalized Nondiabetic Patients With Heart Failure.
Barsheshet et al.
Arch Intern Med 2006;166:1613-1619.
ABSTRACT | FULL TEXT  

Association of Hypoglycemia, Hyperglycemia, and Glucose Variability With Morbidity and Death in the Pediatric Intensive Care Unit
Wintergerst et al.
Pediatrics 2006;118:173-179.
ABSTRACT | FULL TEXT  

Major impact of admission glycaemia on 30 day and one year mortality in non-diabetic patients admitted for myocardial infarction: results from the nationwide French USIC 2000 study
Kadri et al.
Heart 2006;92:910-915.
ABSTRACT | FULL TEXT  

Prognostic significance of the change in glucose level in the first 24 h after acute myocardial infarction: results from the CARDINAL study
Goyal et al.
Eur Heart J 2006;27:1289-1297.
ABSTRACT | FULL TEXT  

Prognostic value of admission glucose and glycosylated haemoglobin levels in acute coronary syndromes
Timmer et al.
QJM 2006;99:237-243.
ABSTRACT | FULL TEXT  

Admission Hyperglycemia and Other Risk Factors as Predictors of Hospital Mortality in a Medical ICU Population
Freire et al.
Chest 2005;128:3109-3116.
ABSTRACT | FULL TEXT  

U-Shaped Relationship of Blood Glucose With Adverse Outcomes Among Patients With ST-Segment Elevation Myocardial Infarction
Pinto et al.
J Am Coll Cardiol 2005;46:178-180.
FULL TEXT  

Admission Glucose and Mortality in Elderly Patients Hospitalized With Acute Myocardial Infarction: Implications for Patients With and Without Recognized Diabetes
Kosiborod et al.
Circulation 2005;111:3078-3086.
ABSTRACT | FULL TEXT  

Acute hyperglycaemia: a 'new' risk factor during myocardial infarction
Ceriello
Eur Heart J 2005;26:328-331.
ABSTRACT | FULL TEXT  

Hyperglycemia in the Hospital
Thompson et al.
Diabetes Spectr. 2005;18:20-27.
ABSTRACT | FULL TEXT  

Blood Glucose Level as a Risk Indicator of Death After Acute Myocardial Infarction
Bobba and Arsura
Arch Intern Med 2004;164:2500-2500.
FULL TEXT  

Insulin, Glycemic Control, and C-Reactive Protein During Myocardial Infarction
Ceriello
Diabetes Care 2004;27:3017-3018.
FULL TEXT