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KMID : 0882420140870050565
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Korean Journal of Medicine
2014 Volume.87 No. 5 p.565 ~ p.573
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The Influence of Admission Hypoglycemia on Clinical Outcomes in Acute Myocardial Infarction Patients with Diabetes Mellitus
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Kim Eun-Jung
Jeong Myoung-Ho
Jeong In-Seok
Oh Sang-Gi
Kim Sang-Hyung
Ahn Young-Keun
Kim Ju-Han
Kim Young-Jo
Chae Shung-Chull
Hong Taek-Jong
Seong In-Whan
Chae Jei-Keon
Kim Chong-Jin
Cho Myeong-Chan
Seung Ki-Bae
Kim Hyo-Soo
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Abstract
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Background/Aims: There are controversies surrounding strict control of blood glucose levels in diabetic patients. Therefore, we evaluated the influence of hypoglycemia at admission on the clinical outcomes of patients with acute myocardial infarction (AMI).
Methods: We analyzed 5,249 diabetic patients who enrolled in the Korean Acute Myocardial Infarction Registry from November 2005 to March 2013. The patients were divided into three groups according to their blood glucose level at admission; Group I: hypoglycemia (≤ 70 mg/dL), Group II: normoglycemia (70-140 mg/dL) and Group III: hyperglycemia (≥ 140 mg/dL). We assessed in-hospital mortality and the major adverse cardiac events based on blood glucose levels at admission.
Results: The mean age was older in group I at 72.6 ± 11.0 years compared to 71.3 ± 10.7 in group II and 70.3 ± 11.1 in group III (p < 0.006). A total of 344 patients died during hospitalization. In-hospital mortality was higher in group I at 12.9%, compared to 5.2% in group II and 6.8% in group III (p < 0.006). Multivariable logistic regression analysis determined that the independent predictors of 1-month mortality were age, Killip class III-IV, cerebrovascular disease, chronic renal failure, acute renal failure, cardiogenic shock, ventricular tachycardia, ejection fraction < 40% and hypoglycemia in admission. The mortality rate at 1 month was significantly higher in group I compared to group II (odds ratio [OR] 3.571; 95% confidence interval [CI] 1.465-8.705, p = 0.005) compared to group II and group III (OR 4.088; 95% CI 1.757-9.511, p = 0.001).
Conclusions: Hypoglycemia on admission was an important predictor of in-hospital and one-month mortality in AMI patients with diabetes mellitus.
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KEYWORD
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Myocardial infarction, Hypoglycemia, Prognosis
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