Acute Myocardial Infarction: High Risk Ventricular Tachyarrhythmias and Admission Glucose Level in Patients with and without Diabetes Mellitus

Rafael      Sanjuan; Maria      L. Blasco; Helena      Martinez-Maicas; Nieves      Carbonell; Gema      Minana; Julio      Nunez; Vicente      Bodi; Juan      Sanchis

doi:10.2174/157339911794940675

Abstract

Objective: The aim of this study was to evaluate the impact of glucose levels on admission and High Risk Ventricular Tachyarrhythmia (HRVT) in hospital mortality in patients with Acute Myocardial Infarction (AMI).

Methods: We studied 1.258 consecutive patients admitted to the Coronary Care Unit with a diagnosis of AMI. Ventricular Fibrillation, sustained and nonsustained Ventricular Tachycardia were considered as HRVT. Association between admission glucose, in-hospital mortality and HRVT was assessed with Cox regression analysis.

Results: The overall incidence of in-hospital HRVT was 20% (254/1258 patients) and in-hospital mortality (115/1.258) was higher in patients with HRVT (20% vs. 6%) (p < 0.001). Diabetes Mellitus (DM) was present in 441 patients (35%). Optimal threshold level of glycemia admission to predict ventricular arrhythmia was 180 mg/dl (AUC = 0.716; 0.66- 0.76)(p < 0.001). Patients with euglycemia on admission ( < 120 mg/dL) had lowest prevalence of HRVT (13%)(OR=0.6; 0.46-0.78) in contrast to non DM patients who presented glucose ≥180 mg/dL that exhibited 2-fold increase of in-hospital HRVT (36%; OR=2.2; 1.6-3)(p < 0.001).

Multivariate risk adjusted hazard ratio (HR) analysis showed that, blood pressure < 100 mmHg (HR=2.4; 1.6- 3.6)(p < 0.001), White Blood Count (WBC) > 10.000 cell count (HR=1.44; 1.02-2)(p=0.04) and admission glycemia ≥180 mg/dL (HR=1.5; 1.04-2.3)( p=0.03) had a significantly increased risk in in-hospital HRTV only in NDM patients

Conclusions: The higher glycemia on admission the higher prevalence of life-threatening arrhythmia and mortality regardless diabetes status in patients presenting with AMI. Elevated initial glucose level and WBC count considered along with other clinical data can assist in life-threatening ventricular arrhythmia in non diabetic patients.

Keywords: Acute myocardial infarction, Admission glycemia, Diabetes mellitus, High risk ventricular tachyarrhythmias, COX Regression Analysis, Hazard Ratio (HR), Malignant Arrhythmias, Acute Coronory Syndromes, Atrial Fibrillation, Lipolysis, Percutaneous Coronory Interventions (PCI)