| Objective:Acute myocardial infarction is often accompanied by stresshyperglycemia, stress hyperglycemia aggravates myocardial damage,leading to heartfailure;ventricular remodeling;malignant arrhythmia;reinfarction;recurrent anginapectoris and other adverse consequences.This article describes the cause ofstress-hyperglycemia after ST segment elevation acute myocardial infarction (STEMI),the mechanism how hyperglycemia aggratating myocardial infarction and how toprevent, discussioning on relevant risk of stress hyperglycemia in patients with STEMIand evaluation of stress hyperglycemia influences on STEMI long-term prognosis andtreatment.Methods: A total of92patients{Male79cases,female13cases,Age25~85yearsold (mean57.63±13.08years)} without diabetes from August2009to April2010in ourhospital were studied. Record any hypertension;coronary heart disease;hypertriglyceridemia;cerebrovascular disease and smoking history. Record the age;sex;Killip classification;creatine kinase (CK);creatine kinase isoenzyme (CK-MB);liverfunction;serum creatinine;left ventricular ejection fraction(LVEF);onset to thrombolysistime;onset time to coronary angiography.All patients were admitted within12hoursafter the onset of STEMI and received the emergent primary percutaneous coronaryintervention(PCI);delayed PCI;emergent thrombolysis and not yet adoptrevascularization. The medicine conservative treatment including Aspirin;ClopidogrelHydrogen Sulfate;angiotensin converting enzyme inhibitors (ACEI);-blockers;statins;low molecular weight heparin etc.The patients were divided in twogroups according to blood-fasting sugar or random blood sugar afteradmission.Stress-hyperglycemia group as the fasting glucose≥7.0mmol/L or randomblood sugar≥11.0mmol/L,n=41;Normal blood sugar group as the fastingglucose<7.0mmol/L or random blood sugar<11.0mmol/L,n=51.The patients were followed-up for1.5years on average, the end of follow-up time in2012October.Among23cases of death,16cases of death due to cardiovascular events{I group of10cases (24.4%); II group of6cases (11.8%)}. The other7cases including2cases in thedigestive tract hemorrhage, cerebral hemorrhage3cases,2cases of cerebral infarction.Risk factors may occur on stress hyperglycemia (age;sex;Killip classification;liverfunction;serum creatinine;LVEF;CK;CK-MB) were analyzed by logistic regressionanalysis, and the risk of death within1-2years was calculated by Cox proportionalhazard regression model.Results:The occurrence of stress-hyperglycemia was44.6%(41/92). The patientsin Stress-hyperglycemia group showed the following characters compared with Nonstress-hyperglycemia group:the age of patients in the I group was toolarge(61.13±11.67vs54.78±13.48,P<0.001);cardiac function Killip class≥II wasmore(26.8%vs3.9%,P<0.01);blood glucose level was higher (12.67±6.99mmol/L vs5.86±0.75mmol/L,P<0.001);CK-MBwashigher(377.29±284.24mmol/Lvs196.65±188.53mmol/L,P<0.01).Besides,Stresshyperglycemia induced liver function damage is heavy, aspartate aminotransferase washigher;Impairment of renal function in two groups were in the normal range.Logisticregression analysis indicated that female(OR8.952,95%CI1.579-50.757,P=0.013),higher Killip class (OR3.530,95%CI1.010-12.336,P=0.048),higher CK-MB (OR9.408,95%CI2.782-31.818,P<0.001)were the independent predictors ofstress-hyperglycemia.Cox proportional hazard regression model presented thatstress-hyperglycemia was an independent predictor for1-2years’mortality (RR1.532,95%CI1.004-2.337,P=0.048).The death of long-term patients with hypertriglyceridemiarisk is normal person1.557times(P=0.041).Conclusion: female, higher killip class, higher CK-MB were the independentpredictors of stress-hyperglycemia after STEMI,and stress-hyperglycemia was the riskfactor for long-term unfavourable prognosisin patients after STEMI.Hypertriglyceridemia may increase the risk of mortality.Control lipid levels may bebeneficial to the long-term prognosis. |
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