Prognostic value of hyperglycemia on-admission in diabetic versus non-diabetic patients presenting with ST-elevation myocardial infarction in Tunisia.

ABSTRACT

BACKGROUND: Hyperglycemia on-admission is a powerful predictor of adverse events in patients presenting for ST-elevation myocardial infarction (STEMI). AIM: In this study, we sought to determine the prognostic value of hyperglycemia on-admission in Tunisian patients presenting with STEMI according to their diabetic status. METHODS: Patients presenting to our center between January 1998 and September 2014 were enrolled. Hyperglycemia was defined as a glucose level ≥11mmol/L. In-hospital prognosis was studied in diabetic and non-diabetic patients. The predictive value for mortality of glycemia level on-admission was assessed by mean of the area under receiver operating characteristic (ROC) curve calculation. RESULTS: A total of 1289 patients were included. Mean age was 60.39±12.8years and 977 (77.3%) patients were male. Prevalence of diabetes mellitus was 70.2% and 15.2% in patients presenting with and without hyperglycemia, respectively (p<0.001). In univariate analysis, hyperglycemia was associated to in-hospital death in diabetic (OR 8.85, 95% CI 2.11-37.12, p<0.001) and non-diabetic patients (OR 2.57, 95% CI 1.39-4.74, p=0.002). In multivariate analysis, hyperglycemia was independently predictive of in-hospital death in diabetic patients (OR 9.6, 95% CI 2.18-42.22, p=0.003) but not in non-diabetic patients (OR 1.93, 95% CI 0.97-3.86, p=0.06). Area under ROC curve of glycemia as a predictor of in-hospital death was 0.792 in diabetic and 0.676 in non-diabetic patients. CONCLUSION: In patients presenting with STEMI, hyperglycemia was associated to hospital death in diabetic and non-diabetic patients in univariate analysis. In multivariate analysis, hyperglycemia was independently associated to in-hospital death in diabetic but not in non-diabetic patients.