In-hospital outcome of acute myocardial infarction and its correlation with plasma sugar levels

ObjectivesTo correlate plasma glucose levels on admission (in diabetics and nondiabetics) with the outcome and majoradverse cardiac events in patients with acute myocardial infarction (AMI). To assess the relationship between stress hyperglycemia and mortality in nondiabetic and diabetic patients having AMI. And also to correlate othervariables like age, sex, systolic blood pressure (SBP), serum creatinine and lipid levels on admission with the outcome.Materials and MethodSixty consecutive patients admitted with ST-elevated myocardial infarction were enrolled. Blood glucose measurements (on admission and discharge) as well as other known prognostic markers like SBP, creatinine, and lipid levels on admission were recorded to investigate their relationship with the occurrence of major cardiac events during their stay in hospital. Diabetics were identified with past history of diabetes mellitus and/or by World Health Organization criteria. Stress hyperglycemia was considered to be present if admission venous plasma sugar exceeded 126 mg/dL without prior diagnosis of diabetes mellitus, and had normal sugar levels on serial estimation and follow-up up to 6 months. Patients were divided into three groups, on the basis of presence of diabetes, stress hyperglycemia and normoglycemia (controls) on admission with 20 patients in each group.ResultsThe incidence of various complications of AMI like left ventricular failure (LVF), cardiogenic shock, arrhythmias and conduction blocks during hospital stay were significantly higher in patients with diabetes (90%) and stress hyperglycemia (75%) as compared to controls (30%) (p<0.05). There was only 10% mortality in patients with normal blood sugar on admission, while 40% mortality was seen in those having plasma sugar levels (PSL) >126mg% at the time of admission (p<0.05). The level of mean initial serum creatinine on admission was higher in nonsmvivors (p<0.05). The mean SBP in survivor was 124.5238 (±28.21541) mmHg, while that in nonsurvivors was 75 (±45.01636) mmHg (p<0.05). There was no statistically significant difference (p>0.05) in the lipid levels between the survivors and nonsurvivors.ConclusionAdmission PSL can be regarded as a strong predictor of complications and mortality after AMI irrespective of presence or absence of diabetes. Thus, stress hyperglycemia carries as bad a prognosis as diabetes. Serum creatinine and SBP on admission also play a prognostic role.