Meta-Analysis of admission hyperglycaemia in acutemyocardial infarction patients treated with primary angioplasty: A cause or a marker of mortality?

Kuljit Singh, Benjamin Hibbert, Balwinder Singh, Kristin Carson, Manuja Premaratne, Michel Le May, Aun Yeong Chong, Margaret Arstall, Derek So

Research output: Contribution to journalReview articlepeer-review

16 Citations (Scopus)

Abstract

Aims : Admission hyperglycaemia (AH) has been associated with worse outcomes in acute myocardial infarction (AMI). In the current review,we evaluated the impact of primary angioplasty (pPCI) on mortality in AMI patients with AH. Our second aim was to evaluate if AH is a marker of baseline risk or an independent predictor of mortality. Methods and results Acomprehensive search of four major databaseswas performed.We included original research studies reporting data on mortality in AMI patients with AH (mean plasma glucose > 156 mg/dL/8.7 mmol) and euglycaemia who were treated with pPCI. Of 481 citations, 12 studies were included in the analysis. Admission hyperglycaemia was associated with a higher 30-day [risk ratio (RR) 4.30, P< 0.0001] and 1-To 3-year mortality (RR 2.26, P < 0.0001). As well, AH was more prevalent in women and in patients with an increasing number of cardiac risk factors or angiographic predictors of mortality, such as previous AMI (RR 0.89, P = 0.01), multivessel coronary disease (RR 0.72, P = 0.0001), and involvement of left anterior descending artery (RR 0.92, P, 0.0001). Moreover, patients with AH had larger infarcts (higher creatine kinase-MB; P = 0.004) and more frequent ventricular arrhythmias (P = 0.002). Conclusion Despite rapid revascularization and treatment of hyperglycaemia, patients with AH continue to have a higher mortality. Admission hyperglycaemia occursmorecommonlyin patientswhohave traditional predictors of worseoutcomes-specifically prior infarction, anterior wall infarctions, and multivessel disease. Likely, AH is a predictor of rather than a bona fide therapeutic target in AMI.

Original languageEnglish
Pages (from-to)220-228
Number of pages9
JournalEuropean Heart Journal - Cardiovascular Pharmacotherapy
Volume1
Issue number4
DOIs
Publication statusPublished or Issued - 1 Oct 2015
Externally publishedYes

Keywords

  • Acute myocardial infarction
  • Admission hyperglycaemia
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

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