Ultra-acute increase in blood glucose during prehospital phase is associated with worse short-
term and long-term survival in ST-elevation myocardial infarction
Sammanfattning
BACKGROUND:
The current study was to investigate the blood glucose changes in ultra-acute phase in patients with
ST-elevation myocardial infarction (STEMI) and its associations with patient outcome.
METHODS:
This study was a retrospective population-based observational study utilizing prospectively
collected registry data complemented with laboratory data. All adult patients with STEMI treated by
emergency medical services (EMS) in the city of Helsinki from January 2006 to December 2010 were
included in the study. Both prehospital and hospital admission glucose values were available from
152 (32%) of all STEMI patients (n = 469).
RESULTS:
Change in blood glucose from prehospital phase to emergency department admission was
significantly higher in non-survivors within 30 days compared to survivors (+1.2 ± 5.1 vs. -0.3 ± 2.4
mmol/l [mean ± SD], P = 0.03). Furthermore, the 3-year survival rate was significantly lower in
patients with an evident (?2 mmol/l) rise in blood glucose (P = 0.02). In patients with impaired left
ventricle function (best ejection fraction < 40%), blood glucose increased more compared to patients
without it (1.2 ± 2.9 vs. 0.4 ± 2.7 mmol/l, P = 0.01). Increase in glucose was correlated with peak
myocardial creatinine kinase (r = 0.17, P = 0.04) as a marker of increased size of infarct, but not with
glycosylated haemoglobin A1C as a marker of chronic hyperglycaemia (r = -0.12, P = 0.27).
CONCLUSIONS:
In patients with STEMI, ultra-acute hyperglycaemia during prehospital phase is associated with
increased mortality, impaired cardiac function and increased size of infarct.