Skip to main content
The Egyptian Journal of Internal Medicine
Download PDF

Influence of admission blood glucose and hemoglobin A1c on outcome of acute myocardial infarction

The Egyptian Journal of Internal Medicine volume 26, pages 21–26 (2014)Cite this article

Abstract

Introduction

Patients either with or without a prior history of diabetes mellitus may present with hyperglycemia during acute myocardial infarction (AMI); it is uncertain whether hyperglycemia upon admission, irrespective of the diagnosis of diabetes, remains an independent predictor of in-hospital morbidity and mortality.

Aim of the study

We aimed in this study to assess the impact of admission blood glucose level on the hospital course and outcome in patients presenting with AMI in ICU.

Patients and methods

We included 50 patients with AMI divided into two groups: group I included 30 patients with admission blood glucose level less than 180 mg/dl and group II included 20 patients with admission blood glucose level 180 mg/dl or more. Group I was subdivided into group IA including 16 patients with HbA1c less than 6% and group IB including 14 patients with HbA1c of 6% or more. All patients were subjected to complete history taking and complete clinical examination; 12-lead ECG was performed for every patient and routine laboratory investigations including cardiac enzymes, admission blood glucose level, and HbA1c were estimated at the time of admission of the patients.

Results

There was significant correlation between admission blood glucose level and history of diabetes mellitus and history of smoking (P = 0.000 and 0.008, respectively). There was also significant correlation between admission blood glucose level and complications of myocardial infarction including sinus tachycardia, arrhythmia, and ICU length of stay (P = 0.008, 0.002, and 0.000, respectively). However, HbA1c level was not found to be correlated with any of the previous parameters.

Conclusion

We concluded that elevated admission glucose level is a strong predictor of short-term adverse outcome in patients with AMIs. However, the prognostic value of diabetic control (i.e. hemoglobin A1c levels) in patients with AMI is still undefined.

References

  1. Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes. a systematic overview. Lancet 2000; 356: 773–778.

    Google Scholar 

  2. Norhammer AM, Ryden L, Malmberg K. Admission plasma glucose. Independent risk factor for long-term prognosis after myocardial infarction even in nondiabetic patients. Diabetes Care 1999; 22: 1827–1831.

    Google Scholar 

  3. Sewardsen M, Vythilingum S, Jialal I, Becker PJ. Prognostic importance of admission plasma glucose in diabetic and non-diabetic patients with acute myocardial infarction. Q J Med 1989; 265: 461–466.

    Google Scholar 

  4. Hammoud T, Tanguay JF, Bourassa MG. Management of coronary artery disease. Therapeutic options in patients with diabetes. J Am Coll Cardiol 2000; 36: 355–365.

    CAS  PubMed  Google Scholar 

  5. Bartnik M, Malmberg K, Norhammar A, Tenerz A, Ohrvik J, Ryde’n L. Newly detected abnormal glucose tolerance: an important predictor of long-term outcome after myocardial infarction. Eur Heart J 2004; 25: 1990–1997.

    Article  CAS  Google Scholar 

  6. Zeller M, Cottin Y, Brindisi MC. RICO Survey Working Group. Impaired fasting glucose and cardiogenic shock in patients with acute myocardial infarction. Eur Heart J 2004; 25: 308–312.

    CAS  PubMed  Google Scholar 

  7. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of longterm complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977986.

    Google Scholar 

  8. Adler AI, Stratton IM, Neil HA, Yudkin JS, Matthews DR, Cull CA, et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ 2000; 321: 412.

    Article  CAS  Google Scholar 

  9. Sacks DB, Bruns DE, Goldstein DE, Maclaren NK, McDonald JM, Parrott M. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem 2002; 48: 436–472.

    Article  CAS  Google Scholar 

  10. Gorus F, Mathieu C, Gerlo E. How should HbA1c measurements be reported? Diabetologia 2006; 49: 7–10.

    Article  CAS  Google Scholar 

  11. The NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009; 360: 1283– 1297.

    Article  Google Scholar 

  12. M Cakmak, N Cakmak, S Cetemen, H Tanriverdi, Y Enc, O Teskin, ID Kilic. The value of admission glycosylated hemoglobin level in patients with acute myocardial infarction. Can J Cardiol 2008; 24: 375–378.

    Article  CAS  Google Scholar 

  13. Pres D, Gasior M, Lekston A, Gierlotka M, Hawranek M, Tajstra M, Buchta P, et al. Relationship between low-density lipoprotein cholesterol level on admission and in-hospital mortality in patients with ST-segment elevation myocardial infarction, with or without diabetes, treated with percutaneous coronary intervention. Kardiol Pol 2010; 68: 1005–1012.

    PubMed  Google Scholar 

  14. Gasior M, Stasik-Pres G, Pres D, Lech P, Gierlotka M, Lekston A, et al. Relationship between blood glucose on admission and prognosis in patients with acute myocardial infarction treated with percutaneous coronary intervention. Kardiol Pol 2007; 65: 1031–1038. discussion 1039– 1040

    PubMed  Google Scholar 

  15. M Kosiborod, DK McGuire. Glycated hemoglobin as a prognostic risk marker in nondiabetic patients after acute myocardial infarction. Circulation 2011; 124: 666–668.

    Article  Google Scholar 

  16. Jorik Rudolf Timmer, Clinical implications of glycometabolic disturbances in acute coronary syndromes / Jorik Rudolf Timmer.[S.l.: s.n.],2005([Ensch ede]: Febodruk).- 203 p.: ill.; 24 cm.

  17. CY Chan, R Li, JY Chan, et al. The value of Admission HbA1c level in diabetic patients with acute coronary syndrome. Clin Cardiol 2011; 34: 507–512.

    Article  Google Scholar 

  18. Y Liu, Y-M Yang, J Zhu, H-Q Tan, Y Liang, JD Li. Prognostic significance of hemoglobin A1c level in patients hospitalized with coronary artery disease. A systematic review and meta-analysis. Cardiovasc Diabetol 2011; 10: 98.

    Article  CAS  Google Scholar 

  19. DeGeare VS, Boura JA, Grines LL, O’Neill WW, Grines CL. Predictive value of the Killip classification in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol 2001; 87: 1035–1038.

    Article  CAS  Google Scholar 

  20. Gosselink AT, Liem AL, Reiffers S, Zijlstra F Prognostic value of predischarge radionuclide ventriculography at rest and exercise after acute myocardial infarction treated with thrombolytic therapy or primary coronary angioplasty. The Zwolle Myocardial Infarction Study Group. Clin Cardiol 1998; 21: 254–260.

    CAS  Google Scholar 

  21. Levetan CS, Passaro M, Jablonski K, Kass M, Ratner RE. Unrecognized diabetes among hospitalized patients. Diabetes Care 1998; 21: 246–249.

    Article  CAS  Google Scholar 

  22. Li D, Zhao L, Liu M, et al. Kinetics of tumor necrosis factor alpha in plasma and the cardioprotective effect of a monoclonal antibody to tumor necrosis factor alpha in acute myocardial infarction. Am Heart J 1999; 137: 1145– 1152.

    Article  CAS  Google Scholar 

  23. Fujita H, Morita I, Murota S. A possible involvement of ion transporter in tumor necrosis factor alpha and cycloheximide-induced apoptosis of endothelial cells. Mediators Inflamm 1999; 8: 211218.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Critical Care Medicine, Faculty of Medicine, Cairo University, 54 Tersa Street Al Haram, Cairo, Egypt

    Hanan E. Zaghla MD (Lecturer of Critical Care)

  2. Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt

    Mahmoud A. Elbadry (Professor of Critical Care Medicine)

  3. Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt

    Alaa M. Ashour (Lecturer of Critical Care Medicine)

  4. Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt

    Mohamed M. Abdelfatah M.B. B.Ch

Authors
  1. Hanan E. Zaghla MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mahmoud A. Elbadry
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alaa M. Ashour
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohamed M. Abdelfatah M.B. B.Ch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hanan E. Zaghla MD.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zaghla, H.E., Elbadry, M.A., Ashour, A.M. et al. Influence of admission blood glucose and hemoglobin A1c on outcome of acute myocardial infarction. Egypt J Intern Med 26, 21–26 (2014). https://doi.org/10.4103/1110-7782.132895

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1110-7782.132895

Keywords