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Relationship between Acute Hyperglycemia and Prognosis in Patients with Acute Myocardial Infarction

Author: LiuYan
Tutor: LiangYuLu
School: Suzhou University
Course: Internal Medicine
Keywords: acute myocardial infarction hyperglycemia diabetes mellitus prognosis inflammatory reaction high-sensitivity C reactive protein white blood cell
CLC: R542.22
Type: Master's thesis
Year: 2011
Downloads: 27
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Abstract

Objective: To study the relationship between acute hyperglycemia and adverse cardiovascular events in patients with acute myocardial infarction (AMI) under different classification, and call AMI survivors to explore relationship between acute hyperglycemia and long-term prognosis. To understand the relationship between hyperglycemia and inflammatory reaction, and then to explore whether increased inflammatory reaction was a mechanism that hyperglycemia cause worse prognosis.Methods:Study 1: The study covered 212 patients with the diagnosis of acute myocardial infarction from January 2007 to December 2009. Based on the level of fasting glucose, All patients were grouped into two groups: high blood glucose group(HBG group) and normal blood glucose group(NBG group) , The general clinical data were compared in two groups. Analysis of the relationship between acute hyperglycemia and adverse cardiovascular events during hospitalization such as heart failure, malignant ventricular arrhythmia and death. According to the records of calling AMI survivors and hospitalization records again, to understand whether they were alive or dead, the situation of taking medicine outside the hospital, myocardial re-infarction and cardiac dysfunction, at an average of 29.4 months after discharge;Study 2: The study covered 155 patients with the diagnosis of acute myocardial infarction from January 2008 to March 2010. All patients were grouped as followed: non-diabetes hyperglycemia(NDHG n=33), diabetes mellitus(DM n=56),non-diabetes normal glucose(NDNG n=66). Analyzing the relationship between fasting glucose and high-sensitivity C reactive protein(his-CRP), white blood cell counts among three groups and studying whether increased inflammatory reaction was a mechanism that hyperglycemia cause worse prognosis;Results: (1)age, serum creatinine, prevalence of hypertension and diabetes mellitus were significantly greater in HBG group than that in NBG group(P <0.05).(2)Mortality of an average of 29.4 months after discharge was higher in HBG group than it in NBG group; in non-diabetic patients with AMI, incidence of heart failure and mortality during hospitalization in HBG group were higher than these in NBG group, and Mortality after discharge was higher in HBG group than it in NBG group higher; in patients with selected PCI, the rate of cardiac dysfunction after discharge was higher in HBG group than it in NBG group; acute hyperglycemia wasn’t associated with prognosis in different type of AMI;(3)Logistic regression analysis showed that acute hyperglycemia were associated with the prevalence of heart failure and mortality during hospitalization in non-diabetic patients with AMI;(4)Fasting glucose was higher in NDHG group and DM group than that in NDNG group (P <0.05), uric acid and CK-MB were higher in NDHG group than these in other two groups, ejection fraction(EF) was lower in NDHG group than that in NDNG group, left ventricular internal diameter at end-systole(LVIDs) was higher in NDHG group than that in NDNG group, the prevalence of hypertension was higher in NDHG group and DM group than that in NDNG group;(5)WBC counts and his-CRP were higher in NDHG group than these in the others, his-CRP was higher in DM group than that in NDNG group(both P<0.05),WBC was similar in DM group and NDNG group.(6) Logistic regression analysis revealed that acute fasting glucose was positively associated with mortality during hospitalization(OR=1.258,95%CI:1.094-1.447,P =0.001), and it still exited after adjustment for age, DM and smoking(OR=1.225,95%CI:1.052-1.426,P =0.009); acute fasting glucose was negatively associated with EF(r=-0.349,P =0.000) and was positively associated with LVIDs(r=0.227,P =0.025).Conclusion: In non-diabetic patients with AMI, acute hyperglycemia were associated with the increased prevalence of heart failure and mortality during hospitalization and long-term mortality, in AMI patients with selected PCI, acute hyperglycemia was associated with the increased prevalence of long-term cardiac dysfunction; acute hyperglycemia was positively associated with the levels of inflammatory factors, and increased inflammatory reaction may be a mechanism that hyperglycemia cause worse prognosis.

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CLC: > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Myocardial diseases > Myocardial infarction
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