• Arthur Shiyovich, Harel Gilutz, and Ygal Plakht.
• Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.
• Postgrad Med. 2021 May 1; 133 (4): 395-403.

AbstractBackground: Diabetes mellitus (DM) in a setting of acute myocardial infarction (AMI) is associated with significant metabolic changes and worse outcomes.Objective: To evaluate the prevalence and the prognostic significance of electrolyte/metabolite disturbances among AMI patients with vs. without DM.Methods: Patients admitted to a tertiary medical center with AMI throughout 2002-2012 were screened. Exclusion criteria were: dialysis, mechanical ventilation, and in-hospital coronary artery bypass graft (CABG) surgery. All the results of the following analyses were obtained: Glucose, Uric Acid, (UA) Calcium, Magnesium, Albumin, Potassium, and Sodium. The primary outcome was in-hospital all-cause mortality.Results: A total of 14,364 AMI patient admissions was evaluated, mean age 68.1 ± 14.4 years, 65.5% males, and 41.2% with DM. Following an adjustment to potential confounders, DM patients had increased risk for significant hyperglycemia, hyperuricemia, hypercalcemia, hypomagnesemia, hyperkalemia, and hyponatremia as well as significantly decreased risk for hypoglycemia, hypermagnesemia, and hypokalemia compared with nondiabetics. Overall, 681 (4.7%) patients died throughout the index admission. Deceased had an increased incidence of electrolyte/metabolite abnormalities versus hospital survivors. The prognostic significance of the different categories of the investigated variables is very similar among diabetics and nondiabetics, except increased and decreased uric acid levels [<4.5 (men); <4.0 (women) and ≥9.0 (men); ≥9.4 (women)] which are associated with worse outcomes among diabetics while hyperglycemia (Glucose ≥213 mg/dL) and increased Potassium levels (Potassium ≥4.4mEq/L) which comprise significantly worse prognosis among nondiabetics.Conclusions: Patients with DM admitted with AMI are at greater risk for electrolyte/metabolite abnormalities which are associated with increased risk for in-hospital mortality. The latter association is similar among patients with and without DM except for hyperglycemia and increased potassium levels (stronger among nondiabetics).

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