Many studies suggest that hyperglycemia at admission is often present in patients with acute coronary syndrome and is also a risk factor for complications and in-hospital death. The risk of in-hospital mortality from all causes increases significantly with elevated blood glucose levels on admission in patients with acute myocardial infarction and without diabetes mellitus. 

Find out in the article on estet-portal.com whether there is an association between hyperglycemia and the risk of mortality in patients with acute myocardial infarction without concomitant diabetes.

 

The role of hyperglycemia in the development of cardiovascular complications

Hyperglycemia often accompanies patients with acute myocardial infarction (MI) on admission, and usually predicts adverse clinical consequences in individuals without diabetes mellitus (DM). 

The results of previous epidemiological studies indicate the presence of hyperglycemia in approximately 25-50% of patients with acute coronary syndrome.

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The presence of hyperglycemia has been shown to affect outcomes in patients with acute coronary syndrome, and these are different in patients with DM compared with those without DM. The risk of developing cardiovascular events is higher in patients with acute myocardial infarction who were not previously diagnosed with diabetes or in those who were diagnosed with this disease only after hospitalization than in patients with normal blood glucose levels. Thus, hyperglycemia plays a greater role in the development of adverse events in patients with acute coronary syndrome and without diabetes than in patients with diabetes.

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The effect of hyperglycemia on the risk of mortality in cardiovascular diseases

Chinese scientists conducted a retrospective study that examined the effect of blood glucose levels at admission on the incidence of adverse events in patients with acute myocardial infarction and without diabetes. 

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This study was based on information from the Cardiovascular Center of Beijing Friendship Hospital Data Bank − CBD BANK. A total of 1698 patients without DM were included in the final analysis who were diagnosed with acute myocardial infarction; (including MI with/without ST-segment elevation) during hospitalization. Optimal medical therapy for acute myocardial infarction was applied to each patient during hospitalization in accordance with current recommendations. Coronary angiography and percutaneous coronary intervention were performed if physicians believed that patients could benefit from surgery. Patients were divided into three groups based on blood glucose levels at admission: euglycemia group ≤140 mg/dl (≤

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All participants underwent 12-lead electrocardiography, transthoracic echocardiography, and laboratory blood tests (CBC, electrolytes, creatinine, lipid profile, glucose, and markers of myocardial necrosis). Five variables, including age, brain natriuretic peptide level, percutaneous coronary intervention, myocardial underreperfusion, and blood glucose levels at admission, were included in the final analysis.

Adverse effects of hyperglycemia in myocardial infarction

The primary endpoint of this study − total in-hospital mortality from all causes. Complications during hospitalization were identified as: cardiogenic shock, stroke (including cerebral infarction and cerebral hemorrhage), fatal cardiac arrhythmias (including ventricular tachycardia and ventricular fibrillation), and heart block (including second and third degree).

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The group of participants with severe hyperglycemia on admission compared with the other two groups had significantly higher levels of fasting blood glucose, levels of all markers of myocardial necrosis and brain natriuretic peptide, cardiac troponin I, creatine kinase-MB, myoglobin. The analysis showed that independent predictors of in-hospital mortality in patients with acute myocardial infarction without concomitant diabetes were: age, brain natriuretic peptide level, insufficient myocardial reperfusion, percutaneous coronary intervention and elevated glucose levels during hospitalization. 

Patients with moderate hyperglycemia and severe hyperglycemia had a higher rate of in-hospital all-cause mortality compared with those with normal blood glucose levels at admission.
Thus, this indicator can be considered as a useful marker for identifying individuals at high risk of mortality among patients with acute myocardial infarction without concomitant diabetes.

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