Prognostic value of admission blood glucose level in patients with and without diabetes mellitus who sustain ST segment elevation myocardial infarction complicated by cardiogenic shock

Title
Prognostic value of admission blood glucose level in patients with and without diabetes mellitus who sustain ST segment elevation myocardial infarction complicated by cardiogenic shock
Author(s)
김영조양정훈[양정훈]송영빈[송영빈]한주영[한주영]최성혁[최성혁]최진호[최진호]이상훈[이상훈]권현철[권현철]송필상[송필상]정명호[정명호]
Keywords
PERCUTANEOUS CORONARY INTERVENTION; CRITICALLY-ILL PATIENTS; STRESS HYPERGLYCEMIA; HOSPITAL MORTALITY; GLYCEMIC CONTROL; RISK-ASSESSMENT; ASSOCIATION; PREDICTORS; OUTCOMES; REGISTRY
Issue Date
201310
Publisher
BIOMED CENTRAL LTD
Citation
CRITICAL CARE, v.17, no.5
Abstract
Introduction: Admission blood glucose (BG) level is a predictor of mortality in patients with ST-segment elevation myocardial infarction (STEMI). However, limited data are available relating admission BG to mortality in patients with STEMI complicated by cardiogenic shock, and it is not known whether diabetic status has an independent effect on this relationship. Methods: Between November 2005 and September 2010, 816 STEMI patients with cardiogenic shock were enrolled in a nationwide, prospective, multi-center registry; 239 (29.3%) had diabetes mellitus (DM). Patients were categorized according to BG levels at admission: <7.8, 7.8-10.9, 11.0-16.5 and >= 16.6 mmol/L. The primary outcome was 30-day mortality. The added values of BG to the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores were assessed by receiver operating characteristic curves and integrated discrimination improvement analyses. Results: Thirty-day mortality was higher in patients with higher admission BG (20.4%, 23.3%, 39.8%, and 43.1% p < 0.001). Among non-diabetic patients, 30-day mortality was predicted by TIMI scores with a c-statistic of 0.615 (95% confidence interval [CI], 0.561-0.662) and GRACE scores with a c-statistic of 0.652 (95% CI, 0.604-0.695). Incorporation of admission BG increased the c-statistic for TIMI score to 0.685 (95% CI, 0.639-0.720, p < 0.001) and GRACE score to 0.708 (95% CI 0.664-0.742, p < 0.001). Additional predictive values for BG were not observed for diabetes. Integrated discrimination improvements (TIMI vs. additional BG and GRACE vs. additional BG) were 0.041 (p < 0.001) and 0.039 (p < 0.001) in non-diabetic patients. Conclusions: In a cohort of patients with STEMI complicated by cardiogenic shock, admission BG was an independent predictor of increased risk of mortality only among patients without DM.
URI
http://hdl.handle.net/YU.REPOSITORY/28794http://dx.doi.org/10.1186/cc13035
ISSN
1466-609X
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의과대학 > 내과학교실 > Articles
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