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Elevated admission glucose is common and associated with high short-term complication burden after acute myocardial infarction: Insights from the VALIDATE-SWEDEHEART study
Karolinska Inst, Karolinska Univ Hosp, Dept Med K2, Cardiol Unit, S1 02, SE-17176 Stockholm, Sweden;Dept Res & Dev, Vaxjo, Region Kronober, Sweden.
Karolinska Inst, Karolinska Univ Hosp, Dept Clin Sci & Educ, Sodersjukhuset, Stockholm, Sweden;Capio St Gorans Hosp, Stockholm, Sweden.
Capio St Gorans Hosp, Stockholm, Sweden.
Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden.
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2019 (English)In: Diabetes & Vascular Disease Research, ISSN 1479-1641, E-ISSN 1752-8984, Vol. 16, no 6, p. 582-584Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the association between admission plasma glucose and cardiovascular events in patients with acute myocardial infarction treated with modern therapies including early percutaneous coronary intervention and modern stents.

Methods: Patients (n = 5309) with established diabetes and patients without previously known diabetes with a reported admission plasma glucose, included in the VALIDATE trial 2014-2016, were followed for cardiovascular events (first of mortality, myocardial infarction, stroke, heart failure) within 180 days. Event rates were analysed by four glucose categories according to the World Health Organization criteria for hyperglycaemia and definition of diabetes. Odds ratios were calculated in a multivariate logistic regression model.

Results: Mean age was 67 +/- 11 years. Previously known diabetes was present in 21.2% (n = 1124). Cardiovascular events occurred in 3.7%, 3.8%, 6.6% and 15.7% in the four glucose level groups and 9.9% in those with known diabetes (p < 0.001), while bleeding complications did not differ significantly (9.1%, 8.5%, 8.4%, 12.2% and 8.5%, respectively). After adjustment, odds ratio (95% confidence interval) was 1.00 (0.65-1.53) for group II, 1.62 (1.14-2.29) for group III and 3.59 (1.99-6.50) for group IV compared to the lowest admission plasma glucose group (group I). The corresponding number for known diabetes was 2.42 (1.71-3.42).

Conclusion: In a well-treated contemporary population of acute myocardial infarction patients, 42% of those without diabetes had elevated admission plasma glucose levels with a greater risk for clinical events already within 180 days. Event rate increased with increasing admission plasma glucose levels. These findings highlight the importance of searching for undetected diabetes in the setting of acute myocardial infarction and that new treatment options are needed to improve outcome.

Place, publisher, year, edition, pages
2019. Vol. 16, no 6, p. 582-584
Keywords [en]
Myocardial infarction, prognosis, diabetes, hyperglycaemia
National Category
Endocrinology and Diabetes Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-399017DOI: 10.1177/1479164119871540ISI: 000485080700001PubMedID: 31476896OAI: oai:DiVA.org:uu-399017DiVA, id: diva2:1378970
Funder
Swedish Heart Lung FoundationSwedish Research CouncilSwedish Foundation for Strategic Research Available from: 2019-12-16 Created: 2019-12-16 Last updated: 2019-12-16Bibliographically approved

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James, StefanLagerqvist, Bo

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