Utjecaj stresne hiperglikemije u akutnom infarktu miokarda na klinički ishod u bolesnika bez šećerne bolesti [Influence of stress hyperglycaemia in acute myocardial infarction on clinical outcomes in patients without diabetes mellitus]

The aim of this study was to investigate the long term impact of stress hyperglycemia in nondiabetic patients with acute myocardial infarction on the incidence of major adverse cardiovascular and cerebrovascular events and new onset type 2 diabetes mellitus. There were 239 consequetive patients with first acute myocardial infarction included into the study after signing the informed consent. All of them were hospitalized in the Coronary Care Unit of the University hospital „Sestre milosrdnice“ in Zagreb from 1. 1. 2005. to 31. 12. 2005. Patients were grouped due to their admission glycemia ( or = 7,8 mmol/L ), and history of diabetes, and followed up for a period of 4 years. The incidence of major adverse cardiovascular and cerebrovascular events was noted, as well as new onset type 2 diabetes mellitus. If after 4 years type 2 diabetes mellitus was not detected, an oral glucose tolerance test was performed. Fisher exact test, Mann – Whitney U test and Cox regression were used for statistical analysis. Statistical significant differences were found for all cause mortality ( p = 0,003 ), both cardiac ( p = 0,034 ) and non-cardiac mortality ( p = 0,017 ), incidence of combined TIA and stroke ( p = 0,024 ), incidence of heart failure ( p < 0,001 ), combined incidence of all MACCE ( p < 0,001 ), and new onset type 2 diabetes mellitus ( p = 0,008 ). There was no difference in the incidence of myocardial reinfarction, cardiac surgery and nontraumatic lower extremity amputation between groups. Independent influence of stress hyperglycemia was found for the incidence of cardiac mortality, combined TIA and stroke, heart failure, and combined incidence of all MACCE. In conclusion, stress hyperglycemia in nondiabetic patients with acute myocardial infarction is related to an increased number of MACCE and new onset diabetes mellitus