Impaired glucose metabolism predicts mortality after a myocardial infarction

Diabetes is a risk factor for increased mortality after a myocardial infarc tion. Whether this applies for patients with hyperglycemia during the acute phase of a acute myocardial infarction is unclear. Therefore we determined the relation between admission plasma glucose level and mortality in a pro spectively collected series of 336 consecutive AMI patients. Patients were divided in four groups based on WHO criteria for glucose levels: I: <5.6 mm ol/l, II: 5.6-8.3 mmol/l, III: 8.4-11.0 mmol/l, IV: 11.1 mmol/1. The averag e age was 68 +/- 11 years with a peak CK of 1378 +/- 160 U/l, 34% were ante rior wall AMIs and 52% were treated with thrombolysis. All patients had a l ong-term follow-up control at an average of 14.2 months. One year mortality rate was 19.3% and rose to 44% in patients with glucose levels > 11.1 mmol /l. The mortality was higher in diabetic patients than in non-diabetic pati ents (40 vs. 16%; P <0.05). Multivariate analysis revealed an independent e ffect of glucose level on mortality. In conclusions, our study in an unsele cted patient population demonstrates that admission plasma glucose level in dependently predicts 1 year mortality even in absence of diagnosed diabetes mellitus. Further studies evaluating the effect of acute insulin intervent ion in reducing mortality are warranted. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.