The Correlation Research Between Stress Hyperglycemia And The Short-term Prognosis Of AMI Patients

ObjectivesEpidemiological studies showed that the incidence of stress hyperglycemia (SHG) in acute myocardial infarction (AMI) patients reached up to 20-25%. SHG was showed to be related to the prognosis of AMI patients. However, most of these studies were from the era of fibrinolytic therapy. Is SHG a risk factor of AMI patients in PCI era especially for diabetes mellitus (DM) and non-DM patients? There are few researches on this question and there are disagreements between them. We have not seen relevant studies in domestic. Therefore, we conducted this study. This study aims to explore the relationship between SHG and the short-term prognosis of AMI patients, including the in-hospital mortality and cardiac function, in all objects and AMI patients with or without diabetes, respectively.MethodsFrom June 2012 to august 2015,557 consecutive patients who were performed Coronary Angiogram (CAG) in Qilu hospital were admitted to our study and retrospectively analyzed. There are 417 males and 150 females and the average age is about 60.79±12.25. According to their medical history,140 diabetic patients and 417 non-diabetic patients were identified. Enrolled patients were divided into non-SHG group and SHG group based on their fasting blood glucose (FBG) within 12h from admission. In addition, the identification of SHG was different in different group. SHG in AMI patients with diabetes was FBG≥11.0mml/L while SHG in all objects or in AMI patients without diabetes was FBG≥7.0mml/L. We collected the general clinical information of the patients, including the sex, age, blood pressure, myocardial infarction area and cardiac function (Killip). We recorded the situation of their past medical history such as coronary heart disease (CHD), diabetes, hypertension, smoke and drink. We collected the relevant laboratorial results such as FBG, AST and serum lipids. We acquired the information about the pathological blood vessels by the coronary angiogram, including the number and size of pathological blood vessels, infarct related artery (IRA). We recorded the left ventricular ejection fraction (LVEF) showed by the echocardiogram for the last time and their outcome in hospital. LVEF abnormal was defined as LVEF<0.5 and LVEF normal was defined as LVEF≥0.5. Compared the above general clinical information and the outcome in hospital, calculated odds ratio (OR) and the confidence interval (CI) through logistic regression by statistical analysis using the SPSS 22.0 software.Results1. For all objects1) SHG was defined as FBG≥7.0mml/L. Compared with the non-SHG group, the SHG group showed more serious condition, as the AST level was higher, more patients with Killip Ⅱ～Ⅳ and ≥2 pathological blood vessels (P<0.05).2) SHG was an independent risk factor of the short-term prognosis of AMI patients. The risk of in-hospital mortality in SHG group is 4.744 times of that in non-SHG group (adjusted OR 8.465,95% CI 2.535-28.272, P=0.001). The risk of LVEF reduction in SHG group is 1.626 times of that in non-SHG group (adjusted OR 2.132,95% CI 1.116-4.076, P=0.022).3) In addition to SHG, age was also an independent risk factor of in-hospital mortality (OR=1.174,95% CI 1.095～1.259, P<0.001), and age, smoke history, Killip Ⅱ～Ⅳ, LAD infarction were also independent risk factors of LVEF reduction.4) The history of DM had no influence on the in-hospital mortality, the rate of LVEF reduction or the average level of LVEF.5) In the subgroup of patients with DM, the patients with FBG≥7.0mmol/L and lower than that had no differences in in-hospital mortality, the rate of LVEF reduction and the average level of LVEF.2. For the DM patients1) SHG was defined as FBG≥11.0mml/L. SHG was an independent risk factors of in-hospital mortality (adjusted OR 9.536,95% CI 1.043-87.205,P=0.046).2) SHG had no relationship with the LVEF reduction.3. For the non-DM patientsSHG was defined as FBG≥7.0mml/L. Similar results with that of all objects were found.ConclusionsSHG was an independent risk factor of the short-term prognosis of AMI patients no matter if they had a DM history. But what is noteworthy is that the level of SHG may be different among different groups (non-DM patients 7.0mmol/L vs. DM patients 11.0mmol/L)This study provides more evidence for the correlation between stress hyperglycemia and the short-term prognosis of AMI patients, and the selection of specific therapeutic regimen for AMI patients with different features.