PMID- 23015602
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20121002
LR  - 20220129
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 2
IP  - 5
DP  - 2012
TI  - Is admission blood glucose concentration a more powerful predictor of mortality 
      after myocardial infarction than diabetes diagnosis? A retrospective cohort 
      study.
LID - 10.1136/bmjopen-2012-001596 [doi]
LID - e001596
AB  - OBJECTIVE: To explore the relative association of admission blood glucose levels 
      and antecedent diabetes on early and long-term survival in a contemporary UK 
      population of patients with ST elevation myocardial infarction (STEMI) and 
      non-STEMI (NSTEMI). DESIGN: Retrospective cohort study based on the Myocardial 
      Ischaemia National Audit Project dataset. SETTING: Tertiary care centre. 
      PARTICIPANTS: 4111 (20.3% known diabetes) consecutive patients admitted with 
      acute myocardial infarction (58.3% STEMI) between October 2002 and September 
      2008. PRIMARY AND SECONDARY OUTCOME MEASURES: All-cause mortality at 30 days and 
      1 year. The relative association of admission blood glucose and of antecedent 
      diabetes with mortality was assessed using multivariate Cox regression analysis. 
      Furthermore, we compared these relationships in patients with STEMI to those with 
      NSTEMI. RESULTS: By 30 days and 1 year, 409 (9.9%) and 677 (16.5%) of patients 
      died. After adjusting for covariates, diabetes did not show independent 
      association with mortality at any time point, in the entire cohort (HR 30 days 
      0.93 (95% CI 0.63 to 1.38); 1 year 1.00 (0.77 to 1.30)) or in subgroups of STEMI 
      (HR 30 days 1.03 (0.65 to 1.64); 1 year 1.08 (0.77 to 1.51)) and NSTEMI (HR 30 
      days 0.62 (0.26 to 1.50); 1 year 0.87 (0.56 to 1.36)). In contrast, after 
      adjusting for covariates, admission glucose showed robust and independent 
      association with mortality in the entire cohort (HR: 30 days 1.07 (1.04 to 1.10); 
      1 year 1.05 (1.03 to 1.08)), and in the subgroup of STEMI (30 days 1.07 (1.03 to 
      1.10); 1 year 1.07 (1.04 to 1.10)), and NSTEMI (HR 30 days 1.07 (1.00 to 1.14); 1 
      year 1.02 (0.97 to 1.06)). CONCLUSIONS: Admission glucose is strongly associated 
      with mortality in all presentations of acute myocardial infarction (AMI), 
      irrespective of established diabetes diagnosis. The increased risk is maintained 
      up to 1 year. Future studies are required to assess the impact of active 
      management of elevated blood glucose in improving mortality in individuals 
      admitted with AMI.
FAU - Gholap, Nitin Narayan
AU  - Gholap NN
AD  - Department of Health Sciences, University of Leicester, Leicester, UK.
FAU - Mehta, Rajnikant Laxmishanker
AU  - Mehta RL
FAU - Ng, Leong
AU  - Ng L
FAU - Davies, Melanie J
AU  - Davies MJ
FAU - Khunti, Kamlesh
AU  - Khunti K
FAU - Squire, Iain B
AU  - Squire IB
LA  - eng
GR  - RP-DG-1210-10183/DH_/Department of Health/United Kingdom
GR  - RP-PG-0606-1272/DH_/Department of Health/United Kingdom
PT  - Journal Article
DEP - 20120925
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
PMC - PMC3467654
EDAT- 2012/09/28 06:00
MHDA- 2012/09/28 06:01
PMCR- 2012/09/25
CRDT- 2012/09/28 06:00
PHST- 2012/09/28 06:00 [entrez]
PHST- 2012/09/28 06:00 [pubmed]
PHST- 2012/09/28 06:01 [medline]
PHST- 2012/09/25 00:00 [pmc-release]
AID - bmjopen-2012-001596 [pii]
AID - 10.1136/bmjopen-2012-001596 [doi]
PST - epublish
SO  - BMJ Open. 2012 Sep 25;2(5):e001596. doi: 10.1136/bmjopen-2012-001596. Print 2012.