Hypoglycemia on admission during acute myocardial infarction events caused higher 30-day mortality in poorly controlled diabetic patients than in well controlled diabetic patients

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 758-779-Cardiometabolic Risk & Vascular Biology
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-765
Sang Ah Lee*1, Jae Min Cho1, Eun Jung Kwon1, Tae Du Kim2, Gwanpyo Koh1 and Dae Ho Lee1
1Jeju National Univ Sch of Med, 2The Donsuncheon Clinic
Background:In patients with acute myocardial infarction (AMI), both hyperglycemia and hypoglycemia increase mortality. However, the increased mortality associated with hypoglycemia warrant further studies.

Methods and results: We analyzed the prognostic significance of hypoglycemia and hyperglycemia in 28,880 AMI patients with or without type 2 diabetes mellitus (T2DM). The patients were enrolled in Korea Acute Myocardial Infarction Registry (KAMIR) from 2005 to 2008 and Korea Working Group on Myocardial Infarction (KorMI) upto 2012 to study clinical outcome of coronary interventions. The patients were divided into 5 groups according to serum glucose levels on admission: 70 or less than; 70-139; 140-199; 200-259; 260 mg/dl or more. 30-day mortality in the lowest and highest glucose groups was higher than in other groups, with the highest mortality in the lowest group in both patients with and without T2DM after adjustments for many factors. However, HbA1c level in patients T2DM was not correlated with 30 day mortality. We also stratified T2DM patients based on HbA1c and serum glucose levels: 1st, < 6.5% and < 70 mg/dL; 2nd, Hb A1c < 6.5% and ≥ 200 mg/dL; 3rd, ≥ 8% and < 70 mg/dL; 4th, A1c ≥ 8% and ≥ 200 mg/dl. Interestingly, the 3rdgroup (with admission hypoglycemia and poor previous glucose control) showed highest 30 day mortality among the groups. Furthermore, among T2DM patients, patients with hyperglycemia on admission had lower 30 day mortality than in those with hypoglycemia regardless of HbA1c level.

Conclusion: Hypoglycemia on admission, especially in poorly controlled T2DM patients strongly predicts high 30-day mortality in AMI patients. These data suggest hypoglycemia on admission may affect clinical outcomes differently in AMI patients according to the presence and metabolic control of T2DM.

Nothing to Disclose: SAL, JMC, EJK, TDK, GK, DHL

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm