• George Lazaros, Dimitris Tsiachris, Charalambos Vlachopoulos, Christina Chrysohoou, Anastasios Milkas, Nikos Papageorgiou, Dimitris Tousoulis, and Christodoulos Stefanadis.
• First Cardiology Clinic, Hippokration Hospital, University of Athens Medical School, 114 Vas Sofias Ave., Athens, Greece. glaz35@hotmail.com
• Hellenic J Cardiol. 2013 Mar 1; 54 (2): 119-25.

IntroductionBoth admission hyperglycemia (AH) and diabetes mellitus adversely affect the prognosis in acute coronary syndromes. We prospectively assessed the predictive role of AH in patients with acute ST-segment elevation myocardial infarction (STEMI).MethodsThree hundred-one consecutive patients hospitalized for STEMI were enrolled. Patients were stratified into four groups based on their history of diabetes and the presence of AH (plasma glucose level >11.0 mmol/l or 200 mg/dl). The pre-specified endpoint was the composite of all-cause mortality, non-fatal MI and stroke after one year follow up.ResultsThe incidence of the endpoint was 19.6% (35 all-cause deaths, 21 non-fatal MIs, and 3 strokes). Non-diabetic patients with AH exhibited a significantly higher incidence of the composite endpoint compared to those with neither diabetes nor AH (50% vs. 15.3%, log rank p<0.001) and diabetics with or without AH (50% vs. 17.2% vs. 19.3%, log rank p<0.05 for both). Ejection fraction (HR 0.946, p=0.007), treatment with primary percutaneous coronary intervention (HR=0.488, p=0.041), and AH in the absence of known diabetes (HR 2.207, p=0.043) were the only independent predictors of the endpoint.ConclusionsAH in non-diabetic STEMI patients is accompanied by a worse long-term prognosis compared to diabetics (with or without AH) or normoglycemic patients and constitutes a potent predictor of an adverse outcome.

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