• Marije M Vis, Krischan D Sjauw, René J van der Schaaf, Jan Baan, Karel T Koch, J Hans DeVries, Jan G P Tijssen, Robbert J de Winter, Jan J Piek, and José P S Henriques.
• Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.
• Am. Heart J. 2007 Dec 1; 154 (6): 1184-90.

BackgroundPrimary percutaneous coronary intervention (PCI) reduces mortality in patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). Despite PCI, mortality in CS is still approximately 50%. Admission glucose concentration is an independent predictor of mortality in patients with STEMI and is associated with the occurrence of CS. Whether admission glucose is also a predictor of mortality in CS patients treated with primary PCI is unexplored. We therefore assessed the relation between admission glucose concentration and 1-year mortality in patients with STEMI with CS without a prior diagnosis of diabetes on admission and treated with PCI.MethodsWe investigated a cohort of 208 consecutive patients with STEMI without a prior diagnosis of diabetes with CS on admission. Patients were classified according to glucose levels at admission: <7.8 mmol/L (group 1, n = 57), 7.8 to 11 mmol/L (group 2, n = 71), and >11.0 mmol/L (group 3, n = 80).ResultsThe overall 1-year mortality was 38%. One-year mortality was 21%, 27%, and 60% in groups I, II, and III, respectively (P < .001). In a multivariate logistic regression analysis, the odds for mortality increased by 16% for every 1 mmol/L increase in plasma glucose concentration (OR 1.155, 95% CI 1.070-1.247), after adjustment for left ventricular ejection fraction <40%, age older than 75 years, male sex, and thrombolysis in myocardial infarction 3 flow after PCI.ConclusionsIn patients with STEMI with CS and without a prior diagnosis of diabetes undergoing primary PCI, admission glucose concentration is a very strong independent predictor for 1-year mortality. Further studies are warranted to determine whether concomitant glycometabolic regulation in patients with STEMI treated with PCI, particularly those with CS, will improve clinical outcome.

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