Relationship of hyperglycemia and prognosis in elderly acute myocardial infarction patients with high risk: a clinical study

Objective　To assess the influence of post-admission random hyperglycemia of elderly patients suffering from acute myocardial infarction (STEMI) with elevation of ST segment on cardiac function, coronary perfusion, and the prognosis of one year later. Methods　A total of 137 STEMI patients aged over 75 years were enrolled in present study, including 69 cases of random blood glucose ≥11mmol/L (hyperglycemia group) and 68 cases of random blood glucose<11mmol/L (control group). All the subjects underwent percutaneous coronary intervention (PCI). The cardiac function before and after operation, postoperative coronary blood flow, serum brain natriuretic peptide (BNP) and hypersensitive C reactive protein (hs-CRP) values of all the patients were retrospectively analyzed. Patients were followed up for major adverse cardiac events (MACE) within 12 months after operation. Results　After operation, the left ventricle ejection fraction (LVEF) was significantly lower in hyperglycemia group than that in control group (42.64%±5.29% vs 54.13%±4.31%, P=0.031), the BNP and hs-CRP levels were significantly higher in hyperglycemia group than that in control group (619.53±145.77ng/L vs 489.46±159.63ng/L, P=0.035; 26.71±11.28mg/L vs 17.89±9.03mg/ L, P=0.023). The proportion of target coronary blood flow TIMI≤2 was relatively higher, and the incidence of MACE in 12 months of follow-up was also higher in hyperglycemia group compared with that in control group (13.94% vs 2.94%, P=0.030; 19.35% vs 10.29%, P=0.031). Cox proportional hazards regression model showed that age (HR=1.03, 95% CI 1.001-1.043, P=0.009), symptom to door time (HR=1.74, 95% CI 1.005-2.102, P=0.039), KILLIP ≥2 (HR=2.02, 95% CI 1.004-2.871, P=0.010), SYNTAX score (HR=2.88, 95% CI 1.105-2.906, P=0.008), hyperglycemia (HR=2.09, 95% CI 1.011-2.439, P=0.014) were the independent predictors of 12 months MACE. Conclusion　Elderly high risk STEMI patients with admission hyperglycemia have worse cardiac function, coronary blood flow and higher incidence of MACE after PCI therapy.