Revision: prognostic impact of baseline glucose levels in acute myocardial infarction complicated by cardiogenic shock—a substudy of the IABP-SHOCK II-trial
- 80 Downloads
Limited data from observational retrospective studies suggest an association between glucose levels and prognosis of patients with cardiogenic shock (CS). The aim of this study was to investigate the prognostic role of glucose at admission in patients with acute myocardial infarction (AMI) complicated by CS included in the largest CS trial to date, the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial.
Methods and results
In the IABP-SHOCK II-trial, patients with CS complicating AMI undergoing early revascularization were randomized to a therapy with vs. without IABP support. Primary and secondary endpoints were mortality within 30 days and 1 year, respectively. Glucose levels were examined at admission. Glucose levels were available in 513 patients. In total, 33.7% of the patients had known diabetes. Patients with diabetes had higher glucose levels compared to those without diabetes (median [interquartile range (IQR)] 13.1 mmol/L [IQR 9.5–18.3] vs. 10.8 mmol/L [IQR 7.8–15.4], p = 0.0003). Patients with glucose concentrations above the median (11.5 mmol/L) had higher 30-day and 1-year mortality compared to those below the median (47.7 vs. 36.5%, p = 0.004; 57.7 vs. 47.1%, p = 0.011, respectively). This negative prognostic impact of increased glucose levels remained significant in multivariate adjustment and was not influenced even after adjustment for the presence or absence of diabetes mellitus.
In patients with CS complicating AMI, increased glucose concentration at admission was an independent predictor for mortality at 30-days and 1-year, independently of the diabetic state.
KeywordsCardiogenic shock Acute myocardial infarction Blood glucose Hyperglycemia Prognosis
Compliance with ethical standards
Conflict of interest
All authors declared that they have no competing interest.
- 2.Kataja A, Tarvasmäki T, Lassus J, Cardoso J, Mebazaa A, Køber L, Sionis A, Spinar J, Carubelli V, Banaszewski M, Marino R, Parissis J, Nieminen MS, Harjola VP (2017) The association of admission blood glucose level with the clinical picture and prognosis in cardiogenic shock—results from the CardShock Study. Int J Cardiol 226:48–52CrossRefPubMedGoogle Scholar
- 4.Mebazaa A, Gayat E, Lassus J, Meas T, Mueller C, Maggioni A, Peacock F, Spinar J, Harjola VP, van Kimmenade R, Pathak A, Mueller T, Tavazzi L, Disomma S, Metra M, Pascual-Figal D, Laribi S, Logeart D, Nouira S, Sato N, Parenica J, Deye N, Boukef R, Collet C, Van den Berghe G, Cohen-Solal A, Januzzi JL Jr, GREAT Network (2013) Association between elevated blood glucose and outcome in acute heart failure: results from an international observational cohort. J Am Coll Cardiol 61:820–829CrossRefPubMedGoogle Scholar
- 10.Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, Buller CE, Jacobs AK, Slater JN, Col J, McKinlay SM, LeJemtel TH (1999) Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock. N Engl J Med 341:625–634CrossRefPubMedGoogle Scholar
- 11.Thiele H, Zeymer U, Neumann F-J, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Fuhrmann J, Böhm M, Ebelt H, Schneider S, Schuler G, Werdan K (2012) Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 367:1287–1296CrossRefPubMedGoogle Scholar
- 12.Thiele H, Zeymer U, Neumann F-J, Ferenc M, Olbrich H-G, Hausleiter J, de Waha S, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Lauer B, Boehm M, Ebelt H, Schneider S, Werdan K, Schuler G (2013) Intraaortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock. Final 12-month results of the randomised IntraAortic Balloon Pump in cardiogenic shock II (IABP-SHOCK II) Trial. Lancet 382:1638–1645CrossRefPubMedGoogle Scholar
- 13.Kosiborod M, Rathore SS, Inzucchi SE, Masoudi FA, Wang Y, Havranek EP, Krumholz HM (2005) Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes. Circulation 111:3078–3086CrossRefPubMedGoogle Scholar
- 16.Straumann E, Kurz DJ, Muntwyler J, Stettler I, Furrer M, Naegeli B, Frielingsdorf J, Schuiki E, Mury R, Bertel O, Spinas GA (2005) Admission glucose concentrations independently predict early and late mortality in patients with acute myocardial infarction treated by primary or rescue percutaneous coronary intervention. Am Heart J 150:1000–1006CrossRefPubMedGoogle Scholar
- 17.Ishihara M, Inoue I, Kawagoe T, Shimatani Y, Kurisu S, Nishioka K, Umemura T, Nakamura S, Yoshida M (2003) Impact of acute hyperglycaemia on left ventricular function after reperfusion therapy in patients with a first anterior wall acute myocardial infarction. Am Heart J 146:674–678CrossRefPubMedGoogle Scholar
- 18.Eitel I, Hintze S, de Waha S, Fuernau G, Lurz P, Desch S, Schuler G, Thiele H (2012) Prognostic impact of hyperglycemia in nondiabetic and diabetic patients with ST-elevation myocardial infarction: insights from contrast-enhanced magnetic resonance imaging. Circ Cardiovasc Imaging 5:708–718CrossRefPubMedGoogle Scholar
- 20.Thiele H, Schuler G, Neumann FJ, Hausleiter J, Olbrich HG, Schwarz B, Hennersdorf M, Empen K, Fuernau G, Desch S, de Waha S, Eitel I, Hambrecht R, Böhm M, Kurowski V, Lauer B, Minden HH, Figulla HR, Braun-Dullaeus RC, Strasser RH, Rochor K, Maier SK, Möllmann H, Schneider S, Ebelt H, Werdan K, Zeymer U (2012) Intraaortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock: design and rationale of the intraaortic balloon pump in cardiogenic shock II (IABP-SHOCK II) trial. Am Heart J 163:938–945CrossRefPubMedGoogle Scholar