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Prognostic value of admission blood glucose level in patients with and without diabetes mellitus who sustain ST segment elevation myocardial infarction complicated by cardiogenic shock
INTRODUCTION: Admission blood glucose (BG) level is a predictor of mortality in patients with ST-segment elevation myocardial infarction (STEMI). However, limited data are available relating admission BG to mortality in patients with STEMI complicated by cardiogenic shock, and it is not known whethe...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056011/ https://www.ncbi.nlm.nih.gov/pubmed/24090250 http://dx.doi.org/10.1186/cc13035 |
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author | Yang, Jeong Hoon Song, Pil Sang Song, Young Bin Hahn, Joo-Yong Choi, Seung-Hyuk Choi, Jin-Ho Lee, Sang Hoon Jeong, Myung-Ho Kim, Young-Jo Gwon, Hyeon-Cheol |
author_facet | Yang, Jeong Hoon Song, Pil Sang Song, Young Bin Hahn, Joo-Yong Choi, Seung-Hyuk Choi, Jin-Ho Lee, Sang Hoon Jeong, Myung-Ho Kim, Young-Jo Gwon, Hyeon-Cheol |
author_sort | Yang, Jeong Hoon |
collection | PubMed |
description | INTRODUCTION: Admission blood glucose (BG) level is a predictor of mortality in patients with ST-segment elevation myocardial infarction (STEMI). However, limited data are available relating admission BG to mortality in patients with STEMI complicated by cardiogenic shock, and it is not known whether diabetic status has an independent effect on this relationship. METHODS: Between November 2005 and September 2010, 816 STEMI patients with cardiogenic shock were enrolled in a nationwide, prospective, multi-center registry; 239 (29.3%) had diabetes mellitus (DM). Patients were categorized according to BG levels at admission: <7.8, 7.8–10.9, 11.0–16.5 and ≥ 16.6 mmol/L. The primary outcome was 30-day mortality. The added values of BG to the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores were assessed by receiver operating characteristic curves and integrated discrimination improvement analyses. RESULTS: Thirty-day mortality was higher in patients with higher admission BG (20.4%, 23.3%, 39.8%, and 43.1% p < 0.001). Among non-diabetic patients, 30-day mortality was predicted by TIMI scores with a c-statistic of 0.615 (95% confidence interval [CI], 0.561–0.662) and GRACE scores with a c-statistic of 0.652 (95% CI, 0.604–0.695). Incorporation of admission BG increased the c-statistic for TIMI score to 0.685 (95% CI, 0.639–0.720, p < 0.001) and GRACE score to 0.708 (95% CI 0.664–0.742, p < 0.001). Additional predictive values for BG were not observed for diabetes. Integrated discrimination improvements (TIMI vs. additional BG and GRACE vs. additional BG) were 0.041 (p < 0.001) and 0.039 (p < 0.001) in non-diabetic patients. CONCLUSIONS: In a cohort of patients with STEMI complicated by cardiogenic shock, admission BG was an independent predictor of increased risk of mortality only among patients without DM. |
format | Online Article Text |
id | pubmed-4056011 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-40560112014-06-13 Prognostic value of admission blood glucose level in patients with and without diabetes mellitus who sustain ST segment elevation myocardial infarction complicated by cardiogenic shock Yang, Jeong Hoon Song, Pil Sang Song, Young Bin Hahn, Joo-Yong Choi, Seung-Hyuk Choi, Jin-Ho Lee, Sang Hoon Jeong, Myung-Ho Kim, Young-Jo Gwon, Hyeon-Cheol Crit Care Research INTRODUCTION: Admission blood glucose (BG) level is a predictor of mortality in patients with ST-segment elevation myocardial infarction (STEMI). However, limited data are available relating admission BG to mortality in patients with STEMI complicated by cardiogenic shock, and it is not known whether diabetic status has an independent effect on this relationship. METHODS: Between November 2005 and September 2010, 816 STEMI patients with cardiogenic shock were enrolled in a nationwide, prospective, multi-center registry; 239 (29.3%) had diabetes mellitus (DM). Patients were categorized according to BG levels at admission: <7.8, 7.8–10.9, 11.0–16.5 and ≥ 16.6 mmol/L. The primary outcome was 30-day mortality. The added values of BG to the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores were assessed by receiver operating characteristic curves and integrated discrimination improvement analyses. RESULTS: Thirty-day mortality was higher in patients with higher admission BG (20.4%, 23.3%, 39.8%, and 43.1% p < 0.001). Among non-diabetic patients, 30-day mortality was predicted by TIMI scores with a c-statistic of 0.615 (95% confidence interval [CI], 0.561–0.662) and GRACE scores with a c-statistic of 0.652 (95% CI, 0.604–0.695). Incorporation of admission BG increased the c-statistic for TIMI score to 0.685 (95% CI, 0.639–0.720, p < 0.001) and GRACE score to 0.708 (95% CI 0.664–0.742, p < 0.001). Additional predictive values for BG were not observed for diabetes. Integrated discrimination improvements (TIMI vs. additional BG and GRACE vs. additional BG) were 0.041 (p < 0.001) and 0.039 (p < 0.001) in non-diabetic patients. CONCLUSIONS: In a cohort of patients with STEMI complicated by cardiogenic shock, admission BG was an independent predictor of increased risk of mortality only among patients without DM. BioMed Central 2013 2013-10-03 /pmc/articles/PMC4056011/ /pubmed/24090250 http://dx.doi.org/10.1186/cc13035 Text en Copyright © 2013 Yang et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Yang, Jeong Hoon Song, Pil Sang Song, Young Bin Hahn, Joo-Yong Choi, Seung-Hyuk Choi, Jin-Ho Lee, Sang Hoon Jeong, Myung-Ho Kim, Young-Jo Gwon, Hyeon-Cheol Prognostic value of admission blood glucose level in patients with and without diabetes mellitus who sustain ST segment elevation myocardial infarction complicated by cardiogenic shock |
title | Prognostic value of admission blood glucose level in patients with and without diabetes mellitus who sustain ST segment elevation myocardial infarction complicated by cardiogenic shock |
title_full | Prognostic value of admission blood glucose level in patients with and without diabetes mellitus who sustain ST segment elevation myocardial infarction complicated by cardiogenic shock |
title_fullStr | Prognostic value of admission blood glucose level in patients with and without diabetes mellitus who sustain ST segment elevation myocardial infarction complicated by cardiogenic shock |
title_full_unstemmed | Prognostic value of admission blood glucose level in patients with and without diabetes mellitus who sustain ST segment elevation myocardial infarction complicated by cardiogenic shock |
title_short | Prognostic value of admission blood glucose level in patients with and without diabetes mellitus who sustain ST segment elevation myocardial infarction complicated by cardiogenic shock |
title_sort | prognostic value of admission blood glucose level in patients with and without diabetes mellitus who sustain st segment elevation myocardial infarction complicated by cardiogenic shock |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056011/ https://www.ncbi.nlm.nih.gov/pubmed/24090250 http://dx.doi.org/10.1186/cc13035 |
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