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Prognostic impact of baseline glucose levels in acute myocardial infarction complicated by cardiogenic shock-a substudy of the IABP-SHOCK II-trial Morphine and Cardiovascular Outcomes Among Patients With Non-ST-Segment Elevation Acute Coronary Syndromes Undergoing Coronary Angiography Operator Experience and Outcomes After Left Main Percutaneous Coronary Intervention Letter by Jiang et al Regarding Article, “Direct Comparison of Cardiac Myosin-Binding Protein C With Cardiac Troponins for the Early Diagnosis of Acute Myocardial Infarction” Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction Long-Term Effect of Ultrathin-Strut Versus Thin-Strut Drug-Eluting Stents in Patients With Small Vessel Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: A Subgroup Analysis of the BIOSCIENCE Randomized Trial Impact of Statins on Cardiovascular Outcomes Following Coronary Artery Calcium Scoring Invasive Management of Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Scientific Statement From the American Heart Association
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Clinical Trial2018 Jun;107(6):517-523.

JOURNAL：Clin Res Cardiol. Article Link

Prognostic impact of baseline glucose levels in acute myocardial infarction complicated by cardiogenic shock-a substudy of the IABP-SHOCK II-trial

Abdin A, Pöss J, Thiele H et al. Keywords: acute myocardial infarction; blood glucose; cardiogenic shock; hyperglycemia; prognosis

ABSTRACT

BACKGROUND - Limited data from observational retrospective studies suggest an association between glucose levels and prognosis of patients with cardiogenic shock (CS). The aim of this study was to investigate the prognostic role of glucose at admission in patients with acute myocardial infarction (AMI) complicated by CS included in the largest CS trial to date, the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial.


METHODS AND RESULTS - In the IABP-SHOCK II-trial, patients with CS complicating AMI undergoing early revascularization were randomized to a therapy with vs. without IABP support. Primary and secondary endpoints were mortality within 30 days and 1 year, respectively. Glucose levels were examined at admission. Glucose levels were available in 513 patients. In total, 33.7% of the patients had known diabetes. Patients with diabetes had higher glucose levels compared to those without diabetes (median [interquartile range (IQR)] 13.1 mmol/L [IQR 9.5-18.3] vs. 10.8 mmol/L [IQR 7.8-15.4], p = 0.0003). Patients with glucose concentrations above the median (11.5 mmol/L) had higher 30-day and 1-year mortality compared to those below the median (47.7 vs. 36.5%, p = 0.004; 57.7 vs. 47.1%, p = 0.011, respectively). This negative prognostic impact of increased glucose levels remained significant in multivariate adjustment and was not influenced even after adjustment for the presence or absence of diabetes mellitus.


CONCLUSIONS - In patients with CS complicating AMI, increased glucose concentration at admission was an independent predictor for mortality at 30-days and 1-year, independently of the diabetic state.

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