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Korean J Med > Volume 87(5); 2014 > Article
The Korean Journal of Medicine 2014;87(5): 565-573.
내원시 저혈당이 당뇨병을 동반한 심근경색증 환자의 예후에 미치는 영향
김은정1, 정명호1, 정인석2, 오상기2, 김상형2, 안영근1, 김주한1, 김영조3, 채성철4, 홍택종5, 성인환6, 채제건7, 김종진8, 조명찬9, 승기배10, 김효수11, 한국인 급성 심근경색증 등록 연구 연구자
1전남대학교병원 순환기내과
2전남대학교병원 흉부외과
3영남대학교병원 순환기내과
4경북대학교병원 순환기내과
5부산대학교병원 순환기내과
6충남대학교병원 순환기내과
7전북대학교병원 순환기내과
8경희대학교병원 순환기내과
9충북대학교병원 순환기내과
10가톨릭대학교 서울성모병원 순환기내과
11서울대학교병원 순환기내과
The Influence of Admission Hypoglycemia on Clinical Outcomes in Acute Myocardial Infarction Patients with Diabetes Mellitus
Eun Jung Kim1, Myung Ho Jeong1, In Seok Jeong2, Sang Gi Oh2, Sang Hyung Kim2, Young keun Ahn1, Ju Han Kim1, Young Jo Kim3, Shung Chull Chae4, Taek Jong Hong5, In Whan Seong6, Jei Keon Chae7, Chong Jin Kim8, Myeong Chan Cho9, Ki Bae Seung10, Hyo Soo Kim11, Korea Acute Myocardial Infarction Registry (KAMIR) Investigators
1Departments of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
2Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Gwangju, Korea
3Department of Cardiovascular Medicine, Yeungnam University Hospital, Daegu, Korea
4Department of Cardiovascular Medicine, Kyungpook National University Hospital, Daegu, Korea
5Department of Cardiovascular Medicine, Department of Cardiovascular Medicine, Pusan National University Hospital, Pusan, Korea
6Department of Cardiovascular Medicine, Chungnam National University Hospital, Daejon, Korea
7Department of Cardiovascular Medicine, Chunbuk National University Hospital, Jeonju, Korea
8Department of Cardiovascular Medicine, KyungHee University Hospital, Seoul, Korea
9Department of Cardiovascular Medicine, Chungbuk National University Hospital, Cheongju, Korea
10Department of Cardiovascular Medicine, The Catholic University of Korea St Mary’s Hospital, Seoul, Korea
11Department of Cardiovascular Medicine, Seoul National University, Seoul, Korea
Corresponding Author: Myung Ho Jeong ,Tel: +82-62-220-6243, Fax: +82-62-227-3105, Email: myungho@chol.com
Received: November 7, 2013;   Revised: February 11, 2014;   Accepted: February 21, 2014.
This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial License (http://creativecommons.org/licenses/bync/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background/Aims:
There are controversies surrounding strict control of blood glucose levels in diabetic patients. Therefore, we evaluated the influence of hypoglycemia at admission on the clinical outcomes of patients with acute myocardial infarction (AMI).

Methods:
We analyzed 5,249 diabetic patients who enrolled in the Korean Acute Myocardial Infarction Registry from November 2005 to March 2013. The patients were divided into three groups according to their blood glucose level at admission; Group I: hypoglycemia (≤ 70 mg/dL), Group II: normoglycemia (70-140 mg/dL) and Group III: hyperglycemia (≥ 140 mg/dL). We assessed in-hospital mortality and the major adverse cardiac events based on blood glucose levels at admission.

Results:
The mean age was older in group I at 72.6 ± 11.0 years compared to 71.3 ± 10.7 in group II and 70.3 ± 11.1 in group III (p < 0.006). A total of 344 patients died during hospitalization. In-hospital mortality was higher in group I at 12.9%, compared to 5.2% in group II and 6.8% in group III (p < 0.006). Multivariable logistic regression analysis determined that the independent predictors of 1-month mortality were age, Killip class III-IV, cerebrovascular disease, chronic renal failure, acute renal failure, cardiogenic shock, ventricular tachycardia, ejection fraction < 40% and hypoglycemia in admission. The mortality rate at 1 month was significantly higher in group I compared to group II (odds ratio [OR] 3.571; 95% confidence interval [CI] 1.465-8.705, p = 0.005) compared to group II and group III (OR 4.088; 95% CI 1.757-9.511, p = 0.001).

Conclusions:
Hypoglycemia on admission was an important predictor of in-hospital and one-month mortality in AMI patients with diabetes mellitus.
Keywords: Myocardial infarction; Hypoglycemia; Prognosis
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