The Influence of Admission Hypoglycemia on Clinical Outcomes in Acute Myocardial Infarction Patients with Diabetes Mellitus

Kim, Eun Jung; Jeong, Myung Ho; Jeong, In Seok; Oh, Sang Gi; Kim, Sang Hyung; Ahn, Young keun; Kim, Ju Han; Kim, Young Jo; Chae, Shung Chull; Hong, Taek Jong; Seong, In Whan; Chae, Jei Keon; Kim, Chong Jin; Cho, Myeong Chan; Seung, Ki Bae; Kim, Hyo Soo

doi:2014.87.5.565

Korean J Med > Volume 87(5); 2014 > Article

Original Article

The Korean Journal of Medicine 2014;87(5):565-573.
Published online November 1, 2014.
DOI: https://doi.org/10.3904/kjm.2014.87.5.565

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

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

Correspondence:
Myung Ho Jeong, Tel: +82-62-220-6243, Fax: +82-62-227-3105, Email: myungho@chol.com

Received: 7 November 2013 • Revised: 11 February 2014 • Accepted: 21 February 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.

Key Words: Myocardial infarction; Hypoglycemia; Prognosis

주제어: 심근경색증; 저혈당; 예후