003: Acute hyperglycemia is associated with adverse clinical and angiographic outcome after angioplasty for acute myocardial infarction with ST elevation

Background Hyperglycemia has been shown to be a powerful predictor of worse outcome after ST segment-elevation myocardial infarction (STEMI). The aim of this study was to investigate the relation between acute hyperglycemia and angiographic and clinical outcome after primary or rescue angioplasty for STEMI. Methods We prospectively included 383 patients who underwent revascularization for STEMI: 332 primary angioplasty and 51 rescue angioplasty, Plasma glucose was measured at hospital admission. Acute hyperglycemia (HG) was defined as plasma glucose of 11 mmol/L, regardless of the diabetic status. Results Among the 383 patients with STEMI included in the study, 158 (41.2%) patients had acute hyperglycemia. There was no difference among the two groups with regard to clinical characteristics, cardiovascular risk factors and hemodynamic parameters. Angioplasty success, TIMI 3 flow and ST segment resolution were significantly lower in acute HG group. On multivariate regression, HG wasn’t found to be an independant predictor of angioplasty success (p=0.08; OR=0.9; 95%IC [0.92–1]) or of ST resolution, however diabetes was independently associated with ST segment resolution after achieving TIMI 3 flow (OR= 3.2; 95% CI [1.02 – 8.1]; p=0.014). Acute hyperglycemia (OR: 3.8; p=0.005) was found to be an independent predictor of in-hospital mortality in multivariate analysis. Among the HG patients, mortality predictors were: glycemia level (OR=1.13; 95%CI [1.03–1.23]; p=0.005), Killip class (OR: 2.14; 95% CI [1.36 – 3.35]; p=0.001), blood hemoglobin level (OR: 0.69; 95%CI [0.53 – 0.9]; p=0.007), and angioplasty success (OR: 0.25; 95%CI [0.08–0.82]; p=0.022). Conclusion Acute hyperglycemia in patients with STEMI is an important predictor of mortality with an increasing mortality risk even beyond 11 mmol/L but diabetes is a better predictor of ST resolution after TIMI 3 restoring. This suggests the usefulness of assessment of glycemic metabolism in the setting of reperfusion for acute myocardial infarction and the beneficial effect of strict glycemic control.