Fasting Glucose in Acute Myocardial Infarction
Incremental value for long-term mortality and relationship with left ventricular systolic function
- Doron Aronson, MD,
- Haim Hammerman, MD,
- Michael R. Kapeliovich, MD, PHD,
- Abeer Suleiman, BSC,
- Yoram Agmon, MD,
- Rafael Beyar, MD, DSC,
- Walter Markiewicz, MD, FACC and
- Mahmoud Suleiman, MD
- From the Department of Cardiology, Rambam Medical Center, and the Bruce Rappaport Faculty of Medicine, Haifa, Israel
- Address correspondence and reprint requests to Doron Aronson, MD, Department of Cardiology, Rambam Medical Center, Haifa 31096, Israel. E-mail: daronson{at}tx.technion.ac.il
Abstract
OBJECTIVE—Elevation of blood glucose is a common metabolic disorder among patients with acute myocardial infarction (AMI) and is associated with adverse prognosis. However, few data are available concerning the long-term prognostic value of elevated fasting glucose during the acute phase of infarction.
RESEARCH DESIGN AND METHODS—We prospectively studied the relationship between fasting glucose and long-term mortality in patients with AMI. Fasting glucose was determined after an ≥8 h fast within 24 h of admission. The median duration of follow-up was 24 months (range 6–48). All multivariable Cox models were adjusted for the Global Registry of Acute Coronary Events (GRACE) risk score.
RESULTS—In nondiabetic patients (n = 1,101), compared with patients with normal fasting glucose (<100 mg/dl), the adjusted hazard ratio for mortality progressively increased with higher tertiles of elevated fasting glucose (first tertile 1.5 [95% CI 0.8–2.9], P = 0.19; second tertile 3.2 [1.9–5.5], P < 0.0001; third tertile 5.7 [3.5–9.3], P < 0.0001). The c statistic of the model containing the GRACE risk score increased when fasting glucose data were added (0.8 ± 0.02–0.85 ± 0.02, P = 0.004). Fasting glucose remained an independent predictor of mortality after further adjustment for ejection fraction. Elevated fasting glucose did not predict mortality in patients with diabetes (n = 462).
CONCLUSIONS—Fasting glucose is a simple robust tool for predicting long-term mortality in nondiabetic patients with AMI. Fasting glucose provides incremental prognostic information when added to the GRACE risk score and left ventricular ejection fraction. Fasting glucose is not a useful prognostic marker in patients with diabetes.
- AMI, acute myocardial infarction
- GRACE, Global Registry of Acute Coronary Events
- LVEF, left ventricular ejection fraction
Footnotes
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A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.
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- Accepted December 28, 2006.
- Received August 15, 2006.
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