Relationship Between Stress Hyperglycemia With Inhospital Mortality And Complications In Patients Withacute Myocardial Infarction

Objective: To investigate the effect of stress hyperglycemia on the mortality andcardiovascular events in patients with acute myocardial infarction(AMI).Methods: The study covered1226patients with the diagnosis of acute myocardialInfarction admitted in CCU from January2010to December2012in the FirstAffiliate Hospital of Dalian University.Based on the level of fasting bloodglucose(FBG),all patients were grouped into two groups:high blood glucosegroup(HBG group,≥7mmol/L) and non-high blood glucose group(non-HBGgroup,＜7mmol/L). Based on the history of diabetes were grouped intonon-diabetes mellitus group(NDM group) and diabetes mellitus group(DM group）.According to the level of FBG, patients within DM and NDM group were furtherdivided into group A（FBG＜7.0mmol/L）,group B（7.0mmol/L≤FBG＜9.0mmol/L）,group C（9.0mmol/L≤FBG＜11.1mmol/L）,group D（FBG≥11.1mmol/L）,respectively.Compare the differences of the mortality and the rate ofacute heart failure,cardiogenic shock and main arrhythmias among these groups.Results:1. The rate of high FBG is34.1%in all AMI,among37%patients withouthistory of diabetes mellitus. Compare with the808non-HBG groups patients, the418HBG group patients had higher mortality(9.1%vs2.1%) and higher rate ofacute heart failure(37.8%vs21.2%),cardiogenic shock(7.9%vs0.7%) and mainarrhythmias(25.6%vs16.5%)(all p＜0.01). 2. The mortality(6.4%vs3.7%) and the rate of acute heart failure(35.9%vs23%)and cardiogenic shock(6.6%vs1.7%) are greater in the362DM group patientsthan the864NDM group (p＜0.05).3. Among the NDM group, the mortality and cardiovascular complicationsincreased incrementally with the increasing of FBG. Compared with group A, themortality and the rate of acute heart failure,cardiogenic shock and mainarrhythmias of group B, group C, group D are significantly higher(all p＜0.05).Compared with group B, that mortality of group D increase obviously(30%vs2.0%, p＜0.01).4. In the DM group,the mortality showed no significant differences with theincreased FBG levels,but the rate of acute heart failure increased incrementally asFBG reached9mmol/L compared with groupA(p＜0.01).5. The mortality of impaired fasting glucose(IFG) patients is similar to thepatients with normal FBG (2.4%vs1.9%, p＞0.05),and significantly lower thanthe patients with FBG≥7.0mmol/L (11.5%vs2.4%, p＜0.01).Conclusion:1. The stress hyperglycemia could be used as a predictor of inhospitalmortality and cardiovascular events for patients with AMI. The elevation of FBGincreases the mortality and the incidence of acute heart failure, cardiogenic shock,and main arrhythmias of patients withAMI.2. But the effects were not consistent between DM and NDM patients. In NDMpatients, as the FBG level increased, the mortality increased significantly, but thisresults was not obtained in DM group. In DM group, the incidence of acute heartfailure was significantly increased as the FBG level increased.