Diabetes Mellitus and Glucose as Predictors of Mortality in Primary Coronary Percutaneous Intervention

Background

Diabetes mellitus and admission blood glucose are important risk factors formortality in ST segment elevation myocardial infarction patients, but theirrelative and individual role remains on debate.

Objective

To analyze the influence of diabetes mellitus and admission blood glucose on themortality of ST segment elevation myocardial infarction patients submitted toprimary coronary percutaneous intervention.

Methods

Prospective cohort study including every ST segment elevation myocardialinfarction patient submitted to primary coronary percutaneous intervention in atertiary cardiology center from December 2010 to May 2012. We collected clinical,angiographic and laboratory data during hospital stay, and performed a clinicalfollow-up 30 days after the ST segment elevation myocardial infarction. Weadjusted the multivariate analysis of the studied risk factors using the variablesfrom the GRACE score.

Results

Among the 740 patients included, reported diabetes mellitus prevalence was 18%. Onthe univariate analysis, both diabetes mellitus and admission blood glucose werepredictors of death in 30 days. However, after adjusting for potential confoundersin the multivariate analysis, the diabetes mellitus relative risk was no longersignificant (relative risk: 2.41, 95% confidence interval: 0.76 - 7.59; p-value:0.13), whereas admission blood glucose remained and independent predictor of deathin 30 days (relative risk: 1.05, 95% confidence interval: 1.02 - 1.09; p-value ≤0.01).

Conclusion

In ST segment elevation myocardial infarction patients submitted to primarycoronary percutaneous intervention, the admission blood glucose was a moreaccurate and robust independent predictor of death than the previous diagnosis ofdiabetes. This reinforces the important role of inflammation on the outcomes ofthis group of patients.