High Glucose at Admission for AMI May Increase Mortality, Cardiogenic Shock Risk

High glucose levels at admission was associated with an increased risk of all-cause mortality and cardiogenic shock during hospitalization in patients with acute myocardial infarction (AMI) without diabetes. These findings were published in Diabetes/Metabolism Research and Reviews.

Researchers sought to evaluate a transient rise in blood glucose levels, known as acute illness, associated with a worse prognosis in patients with AMI during hospitalization and after discharge. All-cause mortality post AMI was associated with worse outcomes for those without diabetes who present with acute illness at admission, compared to patients with diabetes. Researchers aimed to quantify the optimal cut-off values for blood glucose levels at admission in patients with AMI without diabetes and associate their levels with incidence of adverse events.

In this retrospective cohort study, researchers analyzed admission data from patients who were admitted to the People’s Hospital of Xinjiang Uyghur Autonomous Region from August 2011 to January 2022. Patients who were nondiabetic, with blood glucose levels taken upon admission, and a confirmed discharge diagnosis of AMI were included. Patient exclusion criteria included admission or discharge diagnosis of diabetes and those without a random blood glucose data record upon admission. Primary outcome during hospitalization was all-cause mortality and secondary outcomes included cardiogenic shock, ventricular tachycardia, ventricular fibrillation, atrioventricular block, and stroke. Baseline information was extracted at admission and included age, sex, weight, height, smoking status, alcohol consumption status, systolic blood pressure, diastolic blood pressure, heart rate, and history of hypertension and stroke.

In total, 2412 patients were included and analyzed. Patients were separated into 3 groups: patients with glucose levels <140 mg/dL (group 1; n=1856), patients with glucose levels from 140 to 200 mg/dL (group 2; n=409) and patients with glucose levels >200 mg/dl (group 3; n=147). For the primary outcome, researchers reported a total of 236 (9.8%) deaths during hospitalization: 141 patients (7.6%) in group 1, 58 patients (14.2%) in group 2, and 37 patients (25.2%) in group 3.

Researchers noted higher admission glucose levels increased the risk of all-cause mortality with increased risk per 1 mg/dL (adjusted odds ratio [OR], 1.007; 95% CI, 1.004-1.009; P <.001), 9 mg/dL (adjusted OR: 1.06, 95% CI, 1.04-1.08; P <.001), and 18 mg/dL (adjusted OR, 1.13; 95% CI, 1.08-1.17; P <.001) increase in admission glucose. According to multivariate-adjusted spline regression models, risk of all-cause mortality increased in patients with admission glucose ≥122 mg/dL.

For secondary outcomes, a total of 266 (11.0%) patients with AMI experienced cardiogenic shock during hospitalization: 152 (8.2%) in group 1, 65 (15.9%) in group 2, and 49 (33.3%) in group 3. A linear association was found between admission glucose levels and risk of cardiogenic shock in a multivariate adjusted spline regression models; patients with admission glucose ≥111 mg/dL (adjusted OR, 2.36; 95% CI, 1.80-3.12; P <.001) were at an increased risk of cardiogenic shock compared with patients with admission glucose <111 mg/dL. Additionally, in an analysis of subgroup covariates taken at baseline at admission, notable results included the fact that patients who underwent revascularization with admission glucose ≥122 mg/dL were at a higher risk of all‐cause mortality.

Study limitations included insufficient data on continuous monitoring of hospitalized patients, the need to conduct prospective clinical studies to confirm findings, and the single-center design of the study.

The researchers concluded, “These results emphasise the importance of admission glucose as a predictor of adverse events in retrospective cohorts of hospitalised patients. Additionally, managing blood glucose, particularly in patients with AMI and without diabetes, warrants more attention.”