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European Heart Journal Advance Access published online on April 12, 2006
European Heart Journal, doi:10.1093/eurheartj/ehi884
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European Heart Journal © The European Society of Cardiology 2006; All rights reserved
Received October 19, 2005
Revised March 17, 2006
Accepted March 23, 2006

Clinical research

Prognostic significance of the change in glucose level in the first 24 h after acute myocardial infarction: results from the CARDINAL study

Abhinav Goyal 1 *, Kenneth W. Mahaffey 1, Jyotsna Garg 1, Jose C. Nicolau 2, Judith S. Hochman 3, W. Douglas Weaver 4, Pierre Theroux 5, Gustavo B.F. Oliveira 6, Thomas G. Todaro 7, Christopher F. Mojcik 8, Paul W. Armstrong 9, and Christopher B. Granger 1

1 Duke Clinical Research Institute and Duke University Medical Center, PO Box 17969, Durham, NC 27715, USA
2 Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
3 Columbia University, New York, NY, USA
4 Henry Ford Hospital, Detroit, MI, USA
5 Montreal Heart Institute, Montreal, Quebec, Canada
6 Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
7 Procter & Gamble Pharmaceuticals, Mason, OH, USA
8 Alexion Pharmaceuticals, Inc., Cheshire, CT, USA
9 University of Alberta, Edmonton, Alberta, Canada

* To whom correspondence should be addressed.
Abhinav Goyal, E-mail: a.goyal{at}duke.edu


  Abstract

Aims In acute myocardial infarction (AMI), baseline hyperglycaemia predicts adverse outcomes, but the relation between subsequent change in glucose levels and outcomes is unclear. We evaluated the prognostic significance of baseline glucose and the change in glucose in the first 24 h following AMI.

Methods and results We analysed 1469 AMI patients with baseline and 24 h glucose data from the CARDINAL trial database. Baseline glucose and the 24 h change in glucose (24 h glucose level subtracted from baseline glucose) were included in multivariable models for 30- and 180-day mortality. By 30 and 180 days, respectively, 45 and 74 patients had died. In the multivariable 30-day mortality model, neither baseline glucose nor the 24 h change in glucose predicted mortality in diabetic patients (n=250). However, in nondiabetic patients (n=1219), higher baseline glucose predicted higher mortality [hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.04-1.20, per 0.6 mmol/L increase], and a greater 24 h change in glucose predicted lower mortality (HR 0.91, 95% CI 0.86-0.96, for every 0.6 mmol/L drop in glucose in the first 24 h) at 30 days. Baseline glucose and the 24 h change in glucose remained significant multivariable mortality predictors at 180 days in nondiabetic patients.

Conclusion Both higher baseline glucose and the failure of glucose levels to decrease in the first 24 h after AMI predict higher mortality in nondiabetic patients.

Keywords: Acute myocardial infarction; Diabetes; Glucose; Prognosis; Hyperglycemia.
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