Prognostic Value of Admission Glycosylated Hemoglobin and Glucose in Nondiabetic Patients With ST-Segment―Elevation Myocardial Infarction Treated With Percutaneous Coronary Intervention
In nondiabetic patients with ST-segment-elevation myocardial infarction, acute hyperglycemia is associated with adverse outcome. Whether this association is due merely to hyperglycemia as an acute stress response or whether longer-term glycometabolic derangements are also involved is uncertain. It w...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2011-08, Vol.124 (6), p.704-711 |
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| creator | TIMMER, Jorik R HOEKSTRA, Miriam NIJSTEN, Maarten W. N VAN DER HORST, Iwan C. C OTTERVANGER, Jan Paul SLINGERLAND, Robbert J DAMBRINK, Jan-Henk E BILO, Henk J. G ZIJLSTRA, Felix VAN 'T HOF, Amoud W. J |
| description | In nondiabetic patients with ST-segment-elevation myocardial infarction, acute hyperglycemia is associated with adverse outcome. Whether this association is due merely to hyperglycemia as an acute stress response or whether longer-term glycometabolic derangements are also involved is uncertain. It was our aim to determine the association between both acute and chronic hyperglycemia (hemoglobin A(₁c) [HbA(₁c)]) and outcome in nondiabetic patients with ST-segment-elevation myocardial infarction.
This observational study included consecutive patients (n=4176) without known diabetes mellitus admitted with ST-segment-elevation myocardial infarction. All patients were treated with primary percutaneous intervention. Both glucose and HbA(1c) were measured on admission. Main outcome measure was total long-term mortality; secondary outcome measures were 1-year mortality and enzymatic infarct size. One-year mortality was 4.7%, and mortality after total follow-up (3.3 ± 1.5 years) was 10%. Both elevated HbA(1c) levels (P |
| doi_str_mv | 10.1161/CIRCULATIONAHA.110.985911 |
| format | Article |
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This observational study included consecutive patients (n=4176) without known diabetes mellitus admitted with ST-segment-elevation myocardial infarction. All patients were treated with primary percutaneous intervention. Both glucose and HbA(1c) were measured on admission. Main outcome measure was total long-term mortality; secondary outcome measures were 1-year mortality and enzymatic infarct size. One-year mortality was 4.7%, and mortality after total follow-up (3.3 ± 1.5 years) was 10%. Both elevated HbA(1c) levels (P<0.001) and elevated admission glucose (P<0.001) were associated with 1-year and long-term mortality. After exclusion of early mortality (within 30 days), HbA(₁c) remained associated with long-term mortality (P<0.001), whereas glucose lost significance (P=0.09). Elevated glucose, but not elevated HbA(₁c), was associated with larger infarct size. After multivariate analysis, HbA(₁c) (hazard ratio, 1.2 per interquartile range; P<0.01), but not glucose, was independently associated with long-term mortality.
In nondiabetic patients with ST-segment-elevation myocardial infarction, both elevated admission glucose and HbA(₁c) levels were associated with adverse outcome. Both of these parameters reflect different patient populations, and their association with outcome is probably due to different mechanisms. Measurement of both parameters enables identification of these high-risk groups for aggressive secondary risk prevention.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.110.985911</identifier><identifier>PMID: 21768543</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adult ; Angioplasty, Balloon, Coronary ; Anticoagulants - therapeutic use ; Biological and medical sciences ; Biomarkers ; Blood and lymphatic vessels ; Blood Glucose - analysis ; Cardiology. Vascular system ; Combined Modality Therapy ; Coronary heart disease ; Diabetes Mellitus, Type 2 - blood ; Diabetes Mellitus, Type 2 - diagnosis ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Electrocardiography ; Female ; Follow-Up Studies ; Glucose Metabolism Disorders - blood ; Glucose Metabolism Disorders - complications ; Glycated Hemoglobin A - analysis ; Heart ; Humans ; Hyperglycemia - blood ; Kaplan-Meier Estimate ; Male ; Medical sciences ; Middle Aged ; Myocardial Infarction - blood ; Myocardial Infarction - drug therapy ; Myocardial Infarction - mortality ; Myocardial Infarction - pathology ; Myocardial Infarction - therapy ; Netherlands - epidemiology ; Patient Admission ; Prognosis ; Proportional Hazards Models</subject><ispartof>Circulation (New York, N.Y.), 2011-08, Vol.124 (6), p.704-711</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c397t-5550e6eb180d5ae33594201a6427648e7f04df134b98910249e509857791b64b3</citedby><cites>FETCH-LOGICAL-c397t-5550e6eb180d5ae33594201a6427648e7f04df134b98910249e509857791b64b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24425639$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21768543$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>TIMMER, Jorik R</creatorcontrib><creatorcontrib>HOEKSTRA, Miriam</creatorcontrib><creatorcontrib>NIJSTEN, Maarten W. N</creatorcontrib><creatorcontrib>VAN DER HORST, Iwan C. C</creatorcontrib><creatorcontrib>OTTERVANGER, Jan Paul</creatorcontrib><creatorcontrib>SLINGERLAND, Robbert J</creatorcontrib><creatorcontrib>DAMBRINK, Jan-Henk E</creatorcontrib><creatorcontrib>BILO, Henk J. G</creatorcontrib><creatorcontrib>ZIJLSTRA, Felix</creatorcontrib><creatorcontrib>VAN 'T HOF, Amoud W. J</creatorcontrib><title>Prognostic Value of Admission Glycosylated Hemoglobin and Glucose in Nondiabetic Patients With ST-Segment―Elevation Myocardial Infarction Treated With Percutaneous Coronary Intervention</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>In nondiabetic patients with ST-segment-elevation myocardial infarction, acute hyperglycemia is associated with adverse outcome. Whether this association is due merely to hyperglycemia as an acute stress response or whether longer-term glycometabolic derangements are also involved is uncertain. It was our aim to determine the association between both acute and chronic hyperglycemia (hemoglobin A(₁c) [HbA(₁c)]) and outcome in nondiabetic patients with ST-segment-elevation myocardial infarction.
This observational study included consecutive patients (n=4176) without known diabetes mellitus admitted with ST-segment-elevation myocardial infarction. All patients were treated with primary percutaneous intervention. Both glucose and HbA(1c) were measured on admission. Main outcome measure was total long-term mortality; secondary outcome measures were 1-year mortality and enzymatic infarct size. One-year mortality was 4.7%, and mortality after total follow-up (3.3 ± 1.5 years) was 10%. Both elevated HbA(1c) levels (P<0.001) and elevated admission glucose (P<0.001) were associated with 1-year and long-term mortality. After exclusion of early mortality (within 30 days), HbA(₁c) remained associated with long-term mortality (P<0.001), whereas glucose lost significance (P=0.09). Elevated glucose, but not elevated HbA(₁c), was associated with larger infarct size. After multivariate analysis, HbA(₁c) (hazard ratio, 1.2 per interquartile range; P<0.01), but not glucose, was independently associated with long-term mortality.
In nondiabetic patients with ST-segment-elevation myocardial infarction, both elevated admission glucose and HbA(₁c) levels were associated with adverse outcome. Both of these parameters reflect different patient populations, and their association with outcome is probably due to different mechanisms. Measurement of both parameters enables identification of these high-risk groups for aggressive secondary risk prevention.</description><subject>Adult</subject><subject>Angioplasty, Balloon, Coronary</subject><subject>Anticoagulants - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Biomarkers</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Glucose - analysis</subject><subject>Cardiology. Vascular system</subject><subject>Combined Modality Therapy</subject><subject>Coronary heart disease</subject><subject>Diabetes Mellitus, Type 2 - blood</subject><subject>Diabetes Mellitus, Type 2 - diagnosis</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Glucose Metabolism Disorders - blood</subject><subject>Glucose Metabolism Disorders - complications</subject><subject>Glycated Hemoglobin A - analysis</subject><subject>Heart</subject><subject>Humans</subject><subject>Hyperglycemia - blood</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - blood</subject><subject>Myocardial Infarction - drug therapy</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - pathology</subject><subject>Myocardial Infarction - therapy</subject><subject>Netherlands - epidemiology</subject><subject>Patient Admission</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVUcFu1DAQjRCILoVfQOaAOKXYsZ3Ex1VUuist7Ypu4Rg5zmQJcuzWTirtjZ_o1_Rv-BKmuwuIg2XNm_fejOYlyTtGzxjL2cdq-aW6Wc03y6vL-WKOGD1TpVSMPUtmTGYiFZKr58mMUqrSgmfZSfIqxh9Y5ryQL5OTjBV5KQWfJY_r4LfOx7E35Ku2ExDfkXk79DH23pELuzM-7qweoSULGPzW-qZ3RLsWexP2gGB56V3b6waeXNZ67MGNkXzrx-_kepNew3ZA4NfPh3ML99hF3887b3RAjSVL1-lg9ugmwH7QXrmGYKZRO_BTJJUP3umwQ_YI4R7tkP86edFpG-HN8T9Nbj6db6pFurq6WFbzVWq4KsZUSkkhh4aVtJUaOJdKZJTpXGRFLkooOirajnHRqFIxmgkFkuI9i0KxJhcNP00-HHxvg7-bII41nseAtYfl6rLMKD7JkakOTBN8jAG6-jb0A-5dM1o_RVf_Hx1itD5Eh9q3xylTM0D7V_knKyS8PxJ0NNp2QTvTx388ITKZc8V_A8aHp9U</recordid><startdate>20110809</startdate><enddate>20110809</enddate><creator>TIMMER, Jorik R</creator><creator>HOEKSTRA, Miriam</creator><creator>NIJSTEN, Maarten W. 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Miscellaneous</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Glucose Metabolism Disorders - blood</topic><topic>Glucose Metabolism Disorders - complications</topic><topic>Glycated Hemoglobin A - analysis</topic><topic>Heart</topic><topic>Humans</topic><topic>Hyperglycemia - blood</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - blood</topic><topic>Myocardial Infarction - drug therapy</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - pathology</topic><topic>Myocardial Infarction - therapy</topic><topic>Netherlands - epidemiology</topic><topic>Patient Admission</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>TIMMER, Jorik R</creatorcontrib><creatorcontrib>HOEKSTRA, Miriam</creatorcontrib><creatorcontrib>NIJSTEN, Maarten W. 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C</au><au>OTTERVANGER, Jan Paul</au><au>SLINGERLAND, Robbert J</au><au>DAMBRINK, Jan-Henk E</au><au>BILO, Henk J. G</au><au>ZIJLSTRA, Felix</au><au>VAN 'T HOF, Amoud W. J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic Value of Admission Glycosylated Hemoglobin and Glucose in Nondiabetic Patients With ST-Segment―Elevation Myocardial Infarction Treated With Percutaneous Coronary Intervention</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2011-08-09</date><risdate>2011</risdate><volume>124</volume><issue>6</issue><spage>704</spage><epage>711</epage><pages>704-711</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>In nondiabetic patients with ST-segment-elevation myocardial infarction, acute hyperglycemia is associated with adverse outcome. Whether this association is due merely to hyperglycemia as an acute stress response or whether longer-term glycometabolic derangements are also involved is uncertain. It was our aim to determine the association between both acute and chronic hyperglycemia (hemoglobin A(₁c) [HbA(₁c)]) and outcome in nondiabetic patients with ST-segment-elevation myocardial infarction.
This observational study included consecutive patients (n=4176) without known diabetes mellitus admitted with ST-segment-elevation myocardial infarction. All patients were treated with primary percutaneous intervention. Both glucose and HbA(1c) were measured on admission. Main outcome measure was total long-term mortality; secondary outcome measures were 1-year mortality and enzymatic infarct size. One-year mortality was 4.7%, and mortality after total follow-up (3.3 ± 1.5 years) was 10%. Both elevated HbA(1c) levels (P<0.001) and elevated admission glucose (P<0.001) were associated with 1-year and long-term mortality. After exclusion of early mortality (within 30 days), HbA(₁c) remained associated with long-term mortality (P<0.001), whereas glucose lost significance (P=0.09). Elevated glucose, but not elevated HbA(₁c), was associated with larger infarct size. After multivariate analysis, HbA(₁c) (hazard ratio, 1.2 per interquartile range; P<0.01), but not glucose, was independently associated with long-term mortality.
In nondiabetic patients with ST-segment-elevation myocardial infarction, both elevated admission glucose and HbA(₁c) levels were associated with adverse outcome. Both of these parameters reflect different patient populations, and their association with outcome is probably due to different mechanisms. Measurement of both parameters enables identification of these high-risk groups for aggressive secondary risk prevention.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>21768543</pmid><doi>10.1161/CIRCULATIONAHA.110.985911</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Circulation (New York, N.Y.), 2011-08, Vol.124 (6), p.704-711 |
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| source | MEDLINE; American Heart Association Journals; EZB-FREE-00999 freely available EZB journals; Journals@Ovid Complete |
| subjects | Adult Angioplasty, Balloon, Coronary Anticoagulants - therapeutic use Biological and medical sciences Biomarkers Blood and lymphatic vessels Blood Glucose - analysis Cardiology. Vascular system Combined Modality Therapy Coronary heart disease Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - diagnosis Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Electrocardiography Female Follow-Up Studies Glucose Metabolism Disorders - blood Glucose Metabolism Disorders - complications Glycated Hemoglobin A - analysis Heart Humans Hyperglycemia - blood Kaplan-Meier Estimate Male Medical sciences Middle Aged Myocardial Infarction - blood Myocardial Infarction - drug therapy Myocardial Infarction - mortality Myocardial Infarction - pathology Myocardial Infarction - therapy Netherlands - epidemiology Patient Admission Prognosis Proportional Hazards Models |
| title | Prognostic Value of Admission Glycosylated Hemoglobin and Glucose in Nondiabetic Patients With ST-Segment―Elevation Myocardial Infarction Treated With Percutaneous Coronary Intervention |
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