Acta Medica Medianae (Sep 2012)
THE EFFECT OF STRESS INDUCED-HYPERGLYCEMIA ON HOSPITAL TREATMENT OUTCOME IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION WITH ST SEGMENT ELEVATION
Abstract
Elevated glucose level on admission in the number of emergency conditions, including acute myocardial infarction (AMI), is linked to worse outcomes, regardless of the current treatment. The introduction of primary percutaneous coronary intervention (PPCI) in therapy of AMI patients with ST segment elevation (STEMI) has improved the treatment of these patients. However, there are contradictory evidences regarding the impact of stressinduced hyperglycemia on the treatment outcome. The present study is aimed to indentify the effect of stress-induced hyperglycemia on in-hospital prognosis of patients with STEMI treated with AIM-PPCI. Prospective study included 116 patients with a diagnosis of first AMI-STEMI treated with PPCI at the Department of Cardiovascular Diseases, Clinical Center Niš in the period 2010-2011. Immediately after establishing the diagnosis, the patients with adequate medicament preparation were transferred into the angiography room for the coronary stent implantation. Laboratory analysis of the whole blood samples were done immediately after admission and in the next 24 hours. Receiver operator characteristic (ROC) analysis revealed that stress-induced hyperglycemia (glucose 11.2 mmol / L, an area under the curve of 0.812) is a delimiting factor for distinguishing the outcome and survival of patients on admission. The group of patients without stress-induced hyperglycemia had mortality rate about five times less (1/79 -1.2%) than the group of patients with stress-induced hyperglycemia (5/37 -13.5%), p=0.041. Comparing these groups with the incidence of DM, stress-induced hyperglycemia had no significant effect on mortality in the group without DM (1/54 vs. 3/26, ns) and in the group with DM (1/25 vs. 1/11, ns). The cut-off value of glucose, obtained by ROC curve, is 11.2 mmol/L for stressinduced hyperglycemia in patients with STEMI treated with PPCI. This value could determine a significant gradient of risk: patients with glycemia <11.2 mmol/L on admission had almost five times lower risk of mortality in hospital than those with the level of glucose ≥ 1.2mmol/L. Stress-induced hyperglycemia has an equally bad effect on hospital survival in the groups with and without DM.
