Original article                                                     

UDC: 616.127-005.8-02:616-008.9

doi:10.5633/amm.2012.0303

 

 

THE EFFECT OF STRESS INDUCED-HYPERGLYCEMIA ON HOSPITAL  TREATMENT OUTCOME IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION WITH ST SEGMENT ELEVATION

 

Aleksandar Stojković¹, Miloje Tomašević², Nebojša Krstić¹, Zoran Perišić³, Milan Pavlović³, Sonja Šalinger-Martinović³, Svetlana Apostolović³, Lazar Todorović³, Goran Koraćević³, Gordana Nikolić³, Vladimir Miloradović² and Violeta Irić-Ćupić²

 

Cardiovascular Clinic, Clinical Center Niš, Niš, Serbia¹

Univeristy of Kragujevac, Faculty of Medicine, Kragujevac, Serbia²

University of Niš, Faculty of Medicine, Niš, Serbia³

 

Elevated glucose level on admission in the number of  emergency conditions, including acute myocardial infarction (AMI), is linked  to worse outcomes, regardless of the current treatment.

The introduction of primary percutaneous coronary intervention (PPCI) in therapy of AMI patients with ST segment elevation (STEMI) has improved the treatment of these patients. However, there are contradictory evidences regarding the  impact of stress-induced hyperglycemia on the treatment outcome.  The present study is aimed to indentify the effect of stress-induced hyperglycemia on in-hospital prognosis of patients with STEMI treated with AIM-PPCI.

Prospective study included 116 patients with a diagnosis of first AMI-STEMI treated with PPCI at the  Department of Cardiovascular Diseases, Clinical Center Niš in the period 2010-2011. Immediately after establishing the diagnosis, the patients with adequate medicament  preparation were transferred into the angiography room for the coronary stent implantation. Laboratory analysis of the whole blood samples were done immediately after admission and  in the next 24 hours.

Receiver operator characteristic (ROC) analysis revealed that stress-induced hyperglycemia (glucose 11.2 mmol/L, an area under the curve of 0.812) is a delimiting factor for distinguishing the outcome and survival of patients on admission.  The group of patients without stress-induced hyperglycemia had mortality rate about five times less (1/79-1.2%) than the group of patients with stress-induced hyperglycemia (5/37-13.5%), p=0.041. Comparing these groups with the incidence of  DM, stress-induced hyperglycemia had no significant effect on mortality in the group without DM (1/54 vs. 3/26, ns) and in the group with DM (1/25 vs. 1/11, ns).

The  cut-off value of glucose, obtained by ROC curve, is 11.2mmol/L for stress-induced hyperglycemia in patients with STEMI treated with PPCI. This value could  determine a significant gradient of risk: patients with glycemia <11.2mmol/L on admission had almost five times lower risk of mortality in  hospital than those with the level of glucose ≥ 1.2mmol/L. Stress-induced hyperglycemia has an equally bad effect on hospital survival in the groups with and without DM. Acta Medica Medianae 2012;51(3):18-23.

 

Key words: stress-induced hyperglycemia, primary percutaneous coronary

 intervention, acute myocardial infarction