Mustafa Adem TATLISU, ADNAN KAYA, Muhammed KESKİN, Ömer Faruk BAYCAN, Osman KAYAPINAR, Mustafa ÇALIŞKAN

The Impact of Plasma Glucose Levels on In-Hospital and Long-Term Mortality in Non-Diabetic Patients with STSegment Elevation Myocardial Infarction Patients

Objective: Increased admission plasma glucose can be seen in the acute phase of acute coronary syndromes (ACS). Hence, we performed a retrospective study to evaluate the admission plasma glucose concentration in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) and who had no previous diagnosis of Diabetes Mellitus (DM). Methods: This retrospective study included 2504 consecutive confirmed STEMI patients treated with pPCI. The patients were divided into quantiles according to the admission glucose levels. Quantile I: 94 ± 7 mg/dL (n= 626), quantile II: 112 ± 5 mg/dL (n = 626), quantile III: 131 ± 6 mg/dL (n= 626), quantile IV: 184 ± 46 mg/dL (n= 626). Results: Patients with higher plasma glucose (Q4) had 6.6 times higher in-hospital all-cause mortality rates (95% CI: 3.95–9.30) and 3.12 times higher (95% CI: 2.2–4.4) long-term all-cause mortality rates than patients with lower plasma glucose (Q1–Q3), who had lower rates and were used as the reference. This significant relationship remained even after adjustment for all confounders. Conclusions: Even though glucose-lowering therapy is recommended in ACS patients with glucose levels >180 mg/dL, our results showed that high plasma glucose, even lower than 180 mg/dL, could predict in-hospital and long-term mortality.

Non-Diabetik ST-Segment Yükselmeli Myokardiyal İnfarktüs Hastalarında Plazma Glukoz Seviyelerinin Hastane İçi Ve Uzun Dönem Mortalite Üzerine Olan Etkisi

Amaç: Artmış başvuru plazma glukozu Akut Koroner Sendromlarda (AKS) görülebilmektedir. Bu nedenle, Diabetes Mellitus (DM) tanısı olmayan primer perkütan koroner girişi (pPKG) yapılan ST-segment elevasyonlu miyokard infarktüslü (STEMI) hastalarda başvuru plazma glukozunu değerlendirmek amacıyla retrospektif bir çalışma yaptık. Gereç ve Yöntem: Bu retrospektif çalışma pPKG ile tedavi edilmiş doğrulanmış 2504 ardışık STEMI hastasını içermektedir. Hastalar başvuru glukozlarına göre kuantillere bölünmüştür. Kuantil 1: glukoz seviyesi 94 ± 7 mg/dL (n= 626), kuantil II: glukoz seviyesi 112 ± 5 mg/dL (n = 626), kuantil III: glukoz seviyesi 131 ± 6 mg/dL (n= 626), kuantil IV: glukoz seviyesi 184 ± 46 mg/dL (n= 626). Bulgular: Yüksek plazma glukoz seviyesine sahip hastalar (Q4), düşük plazma glukoz seviyeli hastalara (Q1-Q3) göre 6.6 kat daha fazla tüm nedenli hastane içi mortaliteye (95% CI: 3.95–9.30) ve 3.12 kat daha fazla tüm nedenli uzun dönem mortaliteye (95% CI: 2.2–4.4) sahiptir. Bu anlamlı ilişki, tüm karıştırıcı faktörlerle düzeltme yapıldıktan sonra dahi devam etmiştir. Sonuç: Her ne kadar glukoz seviyesi >180 mg/dL olan AKS hastalarında, glukoz düşürücü tedavi önerilse de sonuçlarımız yüksek plazma glukoz seviyesinin, 180 mg/dL’den düşük olsa dahi, hastane içi ve uzun dönem mortaliteyi ön görebildiğini göstermiştir.

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ISSN: 1309-3878
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez