Résumé
Recent data indicated a high prevalence of abnormal glucose metabolism in patients with no history of diabetes mellitus [DM] at the time of acute myocardial infarction [AMI]. The aim of this retrospective study was to assess the predictive value for clinical outcome for admission hyperglycemia in patients presenting with acute ST-elevation myocardial infarction [STEMI]. Other risk factors such as history of DM, hypertension, Body Mass Index [BMI], smoking, serum level of glycosylated haemoglobin [HbA1c] and low density lipoprotein [LDL] were evaluated. The data of two hundred and eighty five [285] patients with STEMI was extracted and evaluated retrospectively. Patients were classified according to admission serum glucose [AG] into three groups: Group 1 with AG level of <=7 mmol/L and group 2 with AG level between >7 and <15 mmol/Land group 3 of AG >/= 15 mmol/L. In the study group the mean age was 59.7 +/- 14 years, range [24-88] and 180 [63%] were male. 173 [60%] patients with STEMI had hyperglycemic with glucose of more than 7 mmol/L with or without history of DM, eighty four [29%] patients had hyperglycemia and history of DM,89 [31%] patients had hyperglycemia [stress] without DM. Thirty two percent had history of hypertension and 26% had history of smoking. The frequency of more than two Major Acute Cardiac Events [MACE] such as pulmonary odema, significant arrhythmias, or cardiogenic shock were at frequency of 70% in group 3.19% in group 2, and 11% in group 1. Thirty patients died during the study [10.5%]: twelve patients [4.2%] were in group 3, eleven patients [3.9%] in group 2 and seven [2.4%] in group 1. The odds ratio of stress hyperglycemia in group 3 compared with group 1 after adjustment for age and sex as predictor of mortality was 3.3 [Cl 0.99-10.98, P=0.032, like wise, the odds ratio in group 2 compared with group 1 after adjustment was 2.4 [Cl: 0.75- 8.07, P=0.065].The history of DM, high serum level of LDL and the level of HBA1 c and Anterior AMI were significant predictors of adverse outcome while other risk factors such as BMI, history of hypertension and smoking were of no significance. These data indicate that hyperglycemia of more than 15 mmol/L on admission without history of DM is powerful predictor of adverse clinical outcome in the setting of acute myocardial infarction. Other useful predictors are history of DM, and high serum level of glycosylated hemoglobin, LDL and the site of anterior MI on ECG. The BMI, history of hypertension and smoking are not useful predictors of adverse mortality