Admission Hyperglycemia in Patients with Acute Myocardial Infarction in Tikrit Teaching Hospital, Tikrit, Iraq

Abstract

Background: Hyperglycemia is common in critically ill patients; it is no longer considered a benign condition in patients with critical illnesses. Hyperglycemia after acute myocardial infarction (AMI) is associated with an increased risk of in-hospital and long term mortalities in patients with and without diabetes. Although the mechanisms underlying this association are not fully understood, this may be due to impaired left ventricular function, increased incidence of the no-reflow phenomenon, and a tendency for aiThythmias. The aims of this study are to determine the frequency of hyperglycemia during AMI and to show the predictors of adverse events following AMI.

Patients and Methods: Hospital based cross-sectional study. That includes 160 patients with AMI who admitted to CCU in the Tikrit Teaching Hospital from December 2013 to July 2014. Hyperglycemia was defined as admission or non-fasting plasma glucose level equal or above 140 mg/dl (7.8 mmol/L) regardless of past history of diabetes. Patients were divided into 3 groups.

Group 1 (n=77 [48.1%]): Normoglycemic patients: Non-diabetic patients, without stress hyperglycemia and admission plasma glucose level <140 mg/d1 (7.8 mmoUL). Group 2 (n=33 [20.6%]): Non-diabetic patients with stress hyperglycemia with admission plasma glucose level equal or above 140 mg/dl (7.8 mmol/L) and Group 3 (n=50 [31.3%]): Diabetic patients, who had a history of treated diabetes mellitus or HbAlc measurement was > 6.5%.

Results: The results indicate that the mean age in normoglycemic, stress hyperglycemic and diabetes mellitus groups were 55.3, 55.1 and 54.4 years respectively with more males' affection in all thrt e groups without significant difference among them. The anterior wall was the most common site of AMI in all 3 groups but without significant difference among them. Killip class 2 was significantly higher in DM group, while Killip class 3 was significantly higher in stress hyperglycemic group. Odds ration and confidence intervals of many variables as predictors of adverse outcome obtained from this study.

Conclusion: This study indicates that admission hyperglycemia is a common finding in patients with AMI and admission hyperglycemia is a predictor of adverse events following ANIL plasma glucose level equal or above 140 mg/dl (7.8 mmoUL) regardless of past history.