Distinct association of admission hyperglycemia with one-year adverse outcome in diabetic and non-diabetic patients with acute ST-elevation myocardial infarction.

INTRODUCTION Both admission hyperglycemia (AH) and diabetes mellitus adversely affect the prognosis in acute coronary syndromes. We prospectively assessed the predictive role of AH in patients with acute ST-segment elevation myocardial infarction (STEMI). METHODS Three hundred-one consecutive patients hospitalized for STEMI were enrolled. Patients were stratified into four groups based on their history of diabetes and the presence of AH (plasma glucose level >11.0 mmol/l or 200 mg/dl). The pre-specified endpoint was the composite of all-cause mortality, non-fatal MI and stroke after one year follow up. RESULTS The incidence of the endpoint was 19.6% (35 all-cause deaths, 21 non-fatal MIs, and 3 strokes). Non-diabetic patients with AH exhibited a significantly higher incidence of the composite endpoint compared to those with neither diabetes nor AH (50% vs. 15.3%, log rank p<0.001) and diabetics with or without AH (50% vs. 17.2% vs. 19.3%, log rank p<0.05 for both). Ejection fraction (HR 0.946, p=0.007), treatment with primary percutaneous coronary intervention (HR=0.488, p=0.041), and AH in the absence of known diabetes (HR 2.207, p=0.043) were the only independent predictors of the endpoint. CONCLUSIONS AH in non-diabetic STEMI patients is accompanied by a worse long-term prognosis compared to diabetics (with or without AH) or normoglycemic patients and constitutes a potent predictor of an adverse outcome.