Initial Serum Glucose Level as a Prognostic Factor in the First Acute Myocardial Infarction in Emergency Department
Date Issued
2005
Date
2005
Author(s)
Hsu, Chin-Wang
DOI
en-US
Abstract
Background & Objectives: Although studies on prognostic factors for acute myocardial infarction (AMI) were available, there were scanty reports on initial glucose levels. Especially initial glucose levels at emergency department (ED) can be presented as early glucose response to stress; it might be associated with short-term and long-term prognosis of first AMI. The aim of the study is to evaluate the prognostic role of initial glucose levels in first AMI patients.
Material and Methods: This study design was a hospital-based retrospective cohort study, recruited first AMI patients from one tertiary hospital ED between January 1, 2001, and December 31, 2003. Patients with previous coronary artery disease history, duration AMI more than 24 hours or referral from other hospital were excluded. Initial glucose levels at ED were stratified into three categories (level I: <=140, II: 140~200, III: >=200 mg/dl). Logistic and Cox’s regression models were applied to estimate one-month short-term and one-year long-term outcomes, respectively.
Results: Total 198 eligible subjects (men: 159, women: 39, mean age 63.1 ± 14.2 years) were recruited into the study. There was 5.1-fold (p<0.0001) higher risk in level II and 6.5-fold (p<0.0001) in level III for short-term prognosis, and 1.7-fold higher risk in level II and 2.9-fold risk in level III for long-term prognosis in patients with first AMI compared with level I. The estimate of survival function for long-term prognosis among three initial glucose levels shows significantly different (logrank test, P=0.0002). After adjusting for sex, age, reperfusion therapy and infarct subtype, the adjusted odds ratio for short-term outcomes progressively increased with higher levels compared with level I (Level II: Odds ratio: 3.87; 95% Confidence Interval [CI], 1.71 to 8.78; P=0.001; level III, 5.16; 95% CI, 1.97 to 13.51; p<0.0001) and the highest initial glucose level still played an important risk factor for long-term prognosis (Hazard ratio: 3.08, 95% CI 1.59 to 5.98, p=0.001).
Conclusions: Higher initial glucose levels in ED were an important and independent predictor of higher risk of short-term and long-term prognosis in patients with first AMI.
Subjects
急性心肌梗塞
預後因子
初始血醣值
prognostic factors
acute myocardial infarction (AMI)
initial glucose levels
Type
thesis
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