Effect of Blood Glucose Concentrations on Admission in Non-Diabetic Versus Diabetic Patients With First Acute Myocardial Infarction on Short- and Long-Term Mortality (from the MONICA/KORA Augsburg Myocardial Infarction Registry)

The aim of this study was to investigate the association between increased admission glucose in nondiabetic (ND) patients and in patients with type 2 diabetes mellitus (T2DM) with first acute myocardial infarctions (AMIs) and 28-day as well as 1- and 3-year case fatality. The Monitoring Trends and Determinants in Cardiovascular Disease (MONICA)/Cooperative Health Research in the Region of Augsburg (KORA) myocardial infarction registry database in Augsburg, Germany, was used, and 1,631 patients without and 659 patients with T2DM (aged 25 to 74 years) who were admitted from 1998 to 2003 with first AMIs were included. Mortality follow-up was carried out in 2005. ND patients with AMIs with admission glucose >152 mg/dl (top quartile) compared with those in the bottom quartile had an odds ratio of 2.82 (95% confidence interval [CI] 1.30 to 6.12) for death within 28 days after multivariate adjustment; correspondingly, patients with T2DM with admission glucose >278 mg/dl (top quartile) compared with those in the bottom quartile (<152 mg/dl) showed a nonsignificantly increased odds ratio of 1.45 (95% CI 0.64 to 3.31). After the exclusion of patients who died within 28 days, a nonsignificantly increased relative risk (RR) was seen between admission blood glucose and 1-year mortality in ND subjects (RR 2.71, 95% Cl 0.90 to 8.15), whereas no increased RR was found in subjects with diabetes (RR 0.99, 95% Cl 0.34 to 2.82). After 3 years, there was no increased risk for death in patients with high admission blood glucose levels, neither for ND patients nor for those with T2DM. In conclusion, elevated admission blood glucose is associated with increased short-term mortality risk in patients with AMIs, particularly in ND subjects. These patients constitute a high-risk group needing aggressive, comprehensive polypharmacotherapy. (C) 2009 Elsevier Inc. All rights reserved. (Am J Cardiol 2009;104:1607-1612)