Utility of admission blood glucose level in prediction of short-term course and extent of coronary artery occlusion in non-diabetic patients with ST segment elevation myocardial infarction

Abstract

Objective

Our aim was to determine the association between admission glucose level and short-term outcome and extent of coronary artery occlusion in non-diabetic patients with ST segment elevation myocardial infarction (STEMI).

Methods

250 consecutive patients were included in this study without known diabetes mellitus admitted with STEMI. Both glucose and HbA1c were measured on admission. All included patients had hemoglobin A (1c) less than 6.5%. In-hospital and 3 months' major cardiac events MACE (mortality, heart failure, arrhythmias, cardiogenic shock and recurrent ischemia) were documented. They were classified into two groups according to the admission mean glucose level (group A with glucose level ≥ 160 ± 52 mg/dl and group B included those glucose level < 160 ± 52 mg/dl).

Results

Cardiac events were significantly higher in group A versus group-B (P < 0.001). In-hospital and 3-month mortality was higher in group-A than group-B patients (p < 0.01). Elevated admission glucose was associated with larger infarct size (P < 0.002). The prevalence of coronary lesions and the multi-vessels disease was significantly higher in group-A versus group-B patients (P < 0.01). After multivariate analysis, glucose level was independently associated with short-term mortality, and MACE (OR = 6.9; P < 0.03 and 2.4; P < 0.02, respectively). ROC analysis showed that the admission blood glucose level of 160 mg/dl is an independent cut-off value (AUC = 0.68; p < 0.001) in prediction of outcome of non-diabetic patients presented with STEMI.

Conclusions

In non-diabetic patients presented with STEMI, elevated admission glucose level was associated with adverse outcome and more severe multi-vessel coronary lesions. The cut-off value was > 160 mg/dl and was considered an independent factor in prediction of outcome of non-diabetics presented with SEMI. Measurement of admission blood glucose level enables identification of this high-risk group for aggressive secondary risk prevention.