Diabetes contributes to 80% mortality in coronary heart disease (CHD). Hyperglycaemia antedates diabetes and is a late stage in the series of events leading to diabetes.
Stress hyperglycaemia on admission with acute myocardial infarction (AMI) has been reported to have an increased risk of in-hospital mortality/morbidity.
We conducted a retrospective study of all AMI admissions to coronary care unit over a six-month period to see the complications in patients with hyperglycaemia on admission.
Case note of 76 male and 24 females were reviewed. Mean age-65 years, (range 41-97). 72 patients had ST segment elevation MI and 60 were thrombolysed.
37 patients had random blood glucose on admission (RBGA) between 7-11 mmols per litre (group A). In 43 cases RBGA was less than 7 mmols per litre (Group-B). 11 patients had RBGA more than 11 mmols per litre (Group-C). RBGA was not known in 9 patients. 8 patients were known to have diabetes.
The incidence of shock, arrhythmia and heart failure was similar in group A and B respectively. Though the incidence was higher in group C with shock (3), heart failure (4), and arrhythmia in (7) out of 11 cases.
The peak CK in all three groups A, B and C respectively was 431U/L (range 21-4894), 318 (39-1538) and 714 (92-2949). Thus infarct size was larger in the presence of hyperglycaemia.
Patients with high blood glucose on admission had more complications and larger infarct size as demonstrated by higher cardiac enzymes.
Hyperglycaemia in group A, may have been related to stress or a reflection of
impaired glucose tolerance.
Patients with AMI and higher RBGA had high incidence of complications and need careful monitoring. Complications were more when hyperglycaemia approached diabetes range.
More studies are needed to see if hyperglycaemia on admission is stress related or indicate underlying undiagnosed diabetes.
08 - 11 Apr 2002
British Endocrine Societies