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ȣ - 530237 213 |
| In-Hospital Outcomes in Diabetic Patients with Acute Myocardial Infarction Admitted to Coronary Care Unit
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| 전남대학교 병원 심혈관계 중환자실¹ , 전남대학교병원 심장센터² , 보건복지가족부 심장질환특성화연구센터³ |
| 이숙현¹, 정명호² ³ ,김성수² , 김현국² , 신은숙¹ , 고점석² ³ , 이민구² ³ , 심두선² ³ , 박근호² ³ , 윤남식² ³ , 윤현주² ³ , 박형욱² ³ , 홍영준² ³ , 김주한² ³ , 안영근² ³ , 조정관² ³ , 박종춘² ³ , 강정채² ³ |
Background: Diabetic patients with poor blood glucose control have a worse prognosis after an acute myocardial infarction (AMI). Data about the impact of blood glucose control on clinical outcomes in diabetic patients after AMI are not so much. The aim of the present study was to evaluate the predictors including HbA1c, blood glucose of in hospital mortality in diabetic patients with AMI admitted to coronary care unit (CCU).
Methods: 249 diabetic patients (169 males, 64.6 ± 10.5 year-old) with AMI admitted CCU were enrolled from Jan 2006 to May 2008. Clinical characteristics, angiographic characteristics, echocardiography, and laboratory examination were evaluated. Blood glucose and HbA1c levels of all patients were measured within three hours of admission. The patients were divided into two groups according to survival in CCU.
Results: Fifteen diabetic patients (6.0%) died in the CCU. In-hospital mortality was more frequently associated with patient with increased age (72.87±9.0 vs. 64.2±10.4, p=0.002), previous myocardial infarction (26.7% vs. 5.6.6%, p=0.013), hypertension (93.3% vs. 58.5%, p=0.008), Killip class IV(60% vs. 10.2%, p<0.001), increase of heart rate (98.93±30.3 vs 81.16±19.3, p<0.001), not underwent PCI (40.0% vs. 85.8%, p<0.001), left main involvement in angiographic finding (20.0% vs 3.4%, p=0.022), use of ventilator (46.7% vs 2.1%, p<0.001). In Cox proportional hazard analysis, increased age [Hazard ratio (HR); 1.244 95% CI=1.074-1.442, p=0.010), Killip class IV (HR; 34.895 95% CI= 4.24-286.84, p=0.001) left main involvement in angiographic finding (HR; 1.047 95% CI=1.014-1.082, p=0.005), high blood glucose (HR; 1.008 95% CI=1.001-1.015, p=0.019) were independent predictors of in-hospital mortality after adjustment for clinical, angiographic, laboratory data.
Conclusions: Increased age, Killip class IV, left main involvement, high blood glucose were associated with increased in hospital mortality in diabetic patients after AMI admitted to CCU. Hyperglycemia in admission rather than HbA1c in diabetic patients were correlated with in hospital mortality.
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