Issue 135 Item 6 Hyperglycemia in Absence of Diabetes Diagnosis Predicts Poor Ou

Outcomes are worse for those patients with hyperglycemia at the time of an acute myocardial infarction, more so then those already diagnosed with diabetes. Hyperglycemia at the time of acute myocardial infarction (AMI) remains an independent predictor of mortality in the thrombolytic era. According to a team of Canadian researchers, the outcome is even worse for patients not previously diagnosed with diabetes.

These findings, say Dr. Jafna L. Cox and associates of Dalhousie University in Halifax, Nova Scotia, "lend support for aggressive screening strategies aimed at the early recognition of diabetes."

As part of the prospective-cohort project, Improving Cardiovascular Outcomes in Nova Scotia (ICONS), Dr. Cox’s group conducted an extensive chart review of all 1,644 Nova Scotia residents hospitalized for AMI during the interval between October 1997 and October 1998. Hyperglycemia was defined as random blood glucose > 198 mg/dL. They describe their research in the Journal of the American College of Cardiology for November 20.

Diabetics with normal blood glucose comprised 10.2% of the cohort, and hyperglycemic diabetics, 16.9%. Patients who were not previously known to have diabetes but who presented with hyperglycemia made up 8.1%, while the remainder of individuals had no history of diabetes and normal blood sugar measurements.

Multivariate analysis revealed that in-hospital mortality was 2.44-fold higher among patients with hyperglycemia without a previous diagnosis of diabetes compared with their normoglycemic counterparts. The odds ratio for diagnosed diabetes without hyperglycemia was 1.87, and for those with hyperglycemia it was 1.91.

"Patients known to have diabetes and those with hyperglycemia without a history of diabetes continued to suffer a relatively worse outcome even up to one year," the Canadian physicians found.

Neither body mass index nor lipid levels were independently correlated with outcome, they note. Thus, it appears that blood glucose alone, rather than hyperglycemia as part of a metabolic syndrome, was associated with adverse prognosis. J Am Coll Cardiol 2002;40:1748-1754.