ABSTRACT
The aim of this study was to evaluate the impact of diabetes mellitus (DM) and glucose levels on the results of treatment of patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary interventions (PCIs). MATERIALS AND METHODS: Data were collected from all patients (n=1280) with STEMI who were admitted to the coronary care unit and underwent PCIs from 2006 to 2015. 212 (16.6%) patients with DM were compared with 1068 (83.4%) patients without DM (non-DM group). To investigate the influence of the blood glucose levels, all patients were divided into two groups above and below the median of blood glycemia (7.52 mmol/l). RESULTS: Thus, 634 patients with high level of blood glycemia (>7.52 mmol/l) were compared with 635 patients with low level of blood glycemia (≤7.52 mmol/l). In comparing of DM and non-DM groups there were no differences in the rate of death (5.2% vs 4.2%, Ñ=0.526), stent thrombosis (1.4% vs 1.0%, Ñ=0.622), recurrent myocardial infarction (MI) (1.4% vs 1.2%, Ñ=0.813) and major adverse cardiac events (MACE) (7.5% vs 5.4%, Ñ=0.228), which included in-hospital death, recurrent MI and stent thrombosis. The rates of angiographic success (92.9% vs 93.8%, Ñ=0.625) and no-reflow (6.6% vs 5%, Ñ=0.327) also were comparable between groups. The rates of death (6.3% vs 2.5%, Ñ=0.001), MACEs (7.6% vs 4.1%, Ñ=0.008), and no-reflow (6.9% vs 3.6%, Ñ=0,009) were significantly higher in patients with high level of blood glycemia (>7.52 mmol/l). Angiographic success rate (95.1% vs 92.1%, Ñ=0.029) was higher in patients with low level of glycemia (≤7.52 mmol/l). After multivariate adjustment, high level of blood glycemia (>7.52 mmol/l) remained an independent predictor of death (OR=2.28; 95% CI 1.18-4.40, Ñ=0.014), MACE (OR=2.08; 95% CI 1.16-3.75, Ñ=0.014) and no-reflow (OR=2.07; 95% CI 1.15-3.74, Ñ=0.015). At the same time DM wasn't associated with death, MACE or no-reflow. CONCLUSION: High level of blood glycemia was an independent predictor of death, MACE and no-reflow in patients with STEMI, undergoing PCI. The presence of DM was not associated with worse in-hospital outcomes.
Subject(s)
Diabetes Mellitus , Myocardial Infarction , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Blood Glucose , Humans , ST Elevation Myocardial Infarction/surgery , Treatment OutcomeABSTRACT
AIM: To investigate the impact of hyperglycemia on the results of percutaneous coronary interventions (PCIs) in patients with acute ST-segment elevation myocardial infarction (ASTEMI). SUBJECTS AND METHODS: A study group consisted of 511 patients with hyperglycemia (blood glucose level (BGL) ≥7.77 mmol/L) who underwent primary PCIs in the period from 2005 to 2015. A comparison group included 579 patients (BGL ≥7.77 mmol/L). RESULTS: Assessment of the results of hospital interventions revealed that the mortality rates in patients with hyperglycemia proved to be higher than in those with normal BGL (6.5 and 2.6%, respectively; p=0.002). No differences were found in the rates of stent thrombosis (1 and 1.4%; p=0.541) and recurrent myocardial infarction (1.2 and 1.6%; p=0.591). Major adverse cardiac events, including death, recurrent infarction, and stent thrombosis, were more frequently determined in the hyperglycemic patients (7.6 and 4.3%; p=0.020). No-reflow phenomenon statistically significantly more frequently developed in the patients with hyperglycemia (6.8 and 3.3%; p=0.007). Binary logistic regression analysis showed that the presence of hyperglycemia served as an independent predictor of hospital mortality (odds ratio (OR) 2.6; 95% confidence interval (CI), 1.4 to 4.8; p=0.002). The application of a random probability sampling technique revealed that mortality remained statistically significantly higher in the hyperglycemic patients than in the normoglycemic individuals at admission (6.7 and 2.6%; Ñ=0.011). CONCLUSION: PCIs in patients with ASTEMI and hyperglycemia are characterized by higher mortality rates and the risk of major adverse cardiac events. Admission hyperglycemia is an independent predictor of hospital mortality.
