European Heart Journal Advance Access originally published online on June 13, 2007
European Heart Journal 2007 28(16):2042; doi:10.1093/eurheartj/ehm231
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The consensus is clearly needed for the definition of stress hyperglycaemia in acute myocardial infarction
Department of Cardiovascular Diseases
Medical Faculty
University Clinical Centre
Bul. Dr Z. Djindjica 48
Nis 18000
Serbia and Montenegro
Tel: +381 18533644 Fax: +381 18238770 E-mail address: gkoracevic{at}yahoo.com
We enjoyed reading the article of Bauters et al.1 about new relation of stress hyperglycaemia with left ventricular remodelling. Stress hyperglycaemia has been proved to be the independent prognostic marker of worse outcome in numerous critical illnesses,2 including acute myocardial infarction (AMI).3,4 Interestingly, the admission hyperglycaemia has been studied very differently in AMI even in last year or two:
- as a blood glucose level < 10 vs.
10 mmol/L (180 mg/dL)5;
- in comparison between tertiles of glycemia6;
- by comparing groups with the admission glucose of < 7.8 vs. 7.8 mmol/L and < 11.1 vs. 11.1 mmol/L7;
- or groups with the admission glucose of < 7.8 vs. 7.8–11.0 mmol/L vs. 11.1 mmol/L8;
- or with/without first fasting glucose level after admission of >7.7 mmol/L9;
- or sextiles of glycaemia.10
Thus, AMI has been an important disease, glycaemia being the vital parameter, stress hyperglycaemia has prognostic value, and consensus is clearly needed for the definition of stress hyperglycaemia.
For studying pathophysiological processes, it may not be so useful only to choose a glycaemic value above which ‘stress hyperglycaemia begins’, if it depends on diabetes mellitus definition, because the definition of diabetes mellitus has been changed and may be expected to change. It may be more rational for scientific purposes to analyse tertiles–sextiles (depending on the number of patients studied).
On the contrary, using, for example, quartiles may not be fully applicable for practitioner and another method probably should be employed in addition: authors may determine the best cut-off value of glycaemia for mortality in their own AMI patients. Using meta-analysis, this may allow the cardiological community to find a concentration of glucose that is good to introduce in routine risk stratification in AMI patients all over the world, as well as more precise value for risk stratification according to age, gender, race, and so on.
We propose that authors should analyse their database in two ways: both by using quartiles and best cut-off value of glycaemia for mortality in AMI patients.
References
- Bauters C, Ennezat PV, Tricot O, Lauwerier B, Lallemant R, Saadouni H, Quandalle P, Jaboureck O, Lamblin N, Le Tourneau T. Stress hyperglycaemia is an independent predictor of left ventricular remodelling after first anterior myocardial infarction in non-diabetic patients. Eur Heart J (2007) 28:546–552.
[Abstract/Free Full Text] - Nasraway S. Review 2005 Research Workshop Hyperglycemia during critical illness. J Parenter Enteral Nutr (2006) 30:254–258.
[Abstract/Free Full Text] - Lavi S, Kapeliovich M, Gruberg L, Roguin A, Boulos M, Grenadier E, Amikam S, Markiewicz W, Beyar R, Hammerman H. Hyperglycemia during acute myocardial infarction in patients who are treated by primary percutaneous coronary intervention: impact on long-term prognosis. Int J Cardiol. Published online ahead of print March 15, 2007.
- Rasoul S, Ottervanger JP, Bilo HJ, Timmer JR, van ‘t Hof AW, Dambrink JH, Dikkeschei LD, Hoorntje JC, de Boer MJ, Zijlstra F. Glucose dysregulation in nondiabetic patients with ST-elevation myocardial infarction: acute and chronic glucose dysregulation in STEMI. Neth J Med (2007) 65:95–100.[Medline]
- Ishii H, Ichimiya S, Kanashiro M, Amano T, Matsubara T, Murohara T. Effects of intravenous nicorandil before reperfusion for acute myocardial infarction in patients with stress hyperglycemia. Diabetes Care (2006) 29:202–206.
[Abstract/Free Full Text] - Ishihara M, Kojima S, Sakamoto T, Asada Y, Kimura K, Miyazaki S, Japanese Acute Coronary Syndrome Study (JACSS) Investigators. Usefulness of combined white blood cell count and plasma glucose for predicting in-hospital outcomes after acute myocardial infarction. Am J Cardiol (2006) 97:1558–1563.[CrossRef][Web of Science][Medline]
- Ishihara M, Inoue I, Kawagoe T, Shimatani Y, Kurisu S, Hata T, Nakama Y, Kijima Y, Kagawa E. Is admission hyperglycaemia in non-diabetic patients with acute myocardial infarction a surrogate for previously undiagnosed abnormal glucose tolerance? Eur Heart J (2006) 27:2413–2419.
[Abstract/Free Full Text] - Timmer J, Ottervanger J, Bilo J, Dambrink J, Miedema K, Hoorntje J, Zijlstra F. Prognostic value of admission glucose and glycosylated haemoglobin levels in acute coronary syndromes. QJM (2006) 99:237–243.
[Abstract/Free Full Text] - Schiele F, Descotes-Genon V, Seronde M, Blonde M, Legalery P, Meneveau N, Ecarnot F, Mercier M, Penfornis A, Thebault L, Boumal D, Bassand J-P, on behalf of the investigators of the ‘Réseau Franc Comtois de Cardiologie’. Predictive value of admission hyperglycaemia on mortality in patients with acute myocardial infarction. Diabetes Med (2006) 23:1370–1376.[CrossRef][Web of Science][Medline]
- Kadri Z, Danchin N, Vaur L, Cottin Y, Guéret P, Zeller M, Lablanche J-M, Blanchard D, Hanania G, Genès N, Cambou J-P, on behalf of the USIC 2000 Investigators. Major impact of admission glycaemia on 30 day and one year mortality in non-diabetic patients admitted for myocardial infarction: results from the nationwide French USIC 2000 study. Am J Cardiol (2006) 97:167–172.[CrossRef][Web of Science][Medline]
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