Clinical impact of admission hyperglycemia on in-hospital mortality in acute myocardial infarction patients

Background Acute hyperglycemia on admission is common in acute myocardial infarction (AMI) patients regardless of diabetic status, and is known as one of prognostic factors. However, the effect of hyperglycemia on non-diabetic patients is still on debate. Methods A total of 12,625 AMI patients (64.0 ± 12.6 years, 26.1% female) who were enrolled in Korea Acute Myocardial Infarction Registry-National Institute of Health between November 2011 and December 2015, were classified into 4367 diabetes (65.4 ± 11.6 years, 30.4% female) and 8228 non-diabetes (63.3 ± 13 years, 23.9% female). Patients were analyzed for in-hospital clinical outcome according to admission hyperglycemic status. Results In diabetic patients, independent predictors of in-hospital mortality were old age, high HbA₁C, pre-Thrombolysis In Myocardial Infarction (TIMI) flow 0, left ventricle ejection fraction < 40%, cardiogenic shock and ventricular tachycardia. In non-diabetic patients, independent predictors of in-hospital mortality were old age, high admission glucose (≥ 200 mg/dL), pre TIMI flow 0, failed percutaneous coronary intervention, low left ventricle ejection fraction < 40%, cardiogenic shock, stent thrombosis and decreased Hb ≥ 5 g/dL. In hospital mortality was significantly higher in diabetic patients compared to non-diabetic patients (5.0% vs. 3.4%, p < 0.001). However, non-diabetic patients with hyperglycemia have significantly higher mortality compared to diabetic patients (17.4% vs. 7.2%, p < 0.001). Comorbidity including cardiogenic shock (p < 0.001), cerebral hemorrhage (p = 0.012), decreased Hb ≥ 5 g/dL (p = 0.013), atrioventricular block (p < 0.001) and ventricular tachycardia (p = 0.007) was higher in non-diabetic with hyperglycemia than in diabetic patients. Conclusions These findings underscore clinical significance of admission hyperglycemia on in-hospital mortality in non-diabetic AMI patients.