Abstract

The aim of the present study was to assess the prognostic implications of admission hyperglycemia in non-diabetic acute myocardial infarction patients. Methods: This was a retrospective analysis of prospectively enrolled consecutive NSTE-ACS patients treated at the Department of Medicine, Rama Medical College, Kanpur, Uttar Pradesh, India for the period of 1.6 years. A total of 500 patients with NSTE-ACS and high BG without history of diabetes were enrolled. Results: There was no significant difference among the three groups in terms of age, sex, hypertension, hyperlipidemia, smoking, and history of myocardial infarction (p> 0:05 for all). However, there were significant differences among the three groups in the incidences of the multivessel disease, renal insufficiency, Killip grade III/IV, and emergency PCI (p< 0:05 for all), as well as the levels of high-sensitivity C- creatine kinase isoenzyme MB (CK-MB) (p< 0:05 for all). The incidences of severe pump failure, malignant arrhythmia, and death were significantly higher in groups B and C than in group A (p< 0:05). The incidences of severe pump failure, malignant arrhythmia, and death were higher in group C than in group B (p< 0:05). Logistic regression analysis was performed with in-hospital death as the dependent variable and the previously identified risk factors as independent variables. The results showed that hyperglycemia, age, renal insufficiency, and severe pump failure were risk factors of in-hospital death. Conclusion: Therefore, hyperglycemia has different effects on the prognosis of patients with diabetes or undiagnosed diabetes. Hyperglycemia is more predictive of adverse events in patients with undiagnosed diabetes compared to those with diagnosed diabetes. Although the pathophysiological mechanism underlying this phenomenon is unknown, there are several explanations. Some undiagnosed diabetic patients, especially those with severe hyperglycemia, may be at high risk because they have never been treated for diabetes.

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