doiSerbia

The influence of stress hyperglycaemia on the prognosis of patients with acute myocardial infarction and temporary electrical cardiac pacing

Stojković Aleksandar (Klinika za kardiovaskularne bolesti, Klinički centar, Niš)
Koraćević Goran (Klinika za kardiovaskularne bolesti, Klinički centar, Niš)
Perišić Zoran (Klinika za kardiovaskularne bolesti, Klinički centar, Niš)
Krstić Nebojša (Klinika za kardiovaskularne bolesti, Klinički centar, Niš)
Pavlović Milan (Klinika za kardiovaskularne bolesti, Klinički centar, Niš)
Todorović Lazar (Klinika za kardiovaskularne bolesti, Klinički centar, Niš)
Glasnović Jozef (Klinika za kardiovaskularne bolesti, Klinički centar, Niš)
Burazor Ivana (Klinika za kardiovaskularne bolesti, Klinički centar, Niš)
Apostolović Svetlana (Klinika za kardiovaskularne bolesti, Klinički centar, Niš)
Nikolić Gordana (Klinika za zaštitu mentalnog zdravlja, Klinički centar, Niš)
Kostić Tomislav (Klinika za kardiovaskularne bolesti, Klinički centar, Niš)
Branković Nataša (Fakultet sporta i fizičkog vaspitanja, Niš)

Introduction. Elevated glucose levels on admission in many emergency conditions, including acute myocardial infarction (AMI), have been identified as a predictor of hospital mortality. Objective. Since there are no data in the literature related to stress hyperglycaemia (SH) in patients with both AIM and temporary electrical cardiac pacing, we aimed to investigate the influence of stress hyperglycaemia on the prognosis of patients with AMI and temporary electrical cardiac pacing. Methods. The prospective study included 79 patients with diagnosed AMI with ST-segment elevation (STEMI), admitted to the Coronary Care Unit of the Clinic for Cardiovascular Diseases, Clinical Centre Niš, from 2004 to 2007, who were indicated for temporary electrical cardiac pacing. The blood was sampled on admission for lab analysis, glucose levels were determined (as well as markers of myocardial necrosis - troponin I, CK-MB). Echocardiographic study was performed and ejection fraction was evaluated by using area length method. Results. The ROC analysis indicated that the best glycaemic level on admission, which could be used as a predictor of mortality, was 10.00 mmol/l, and the area under the curve was 0.82. In the group without SH, hospital mortality was 3-fold lower 11/48 (22.91%) compared to the group with SH 19/31 (61.29%), p<0.0001. Patients with SH were more likely to have higher troponin levels, Killip >1, lower ejection fraction and heart rate, as well as systolic blood pressure. Conclusion. The best cut-off value for SH in patients with AMI (STEMI) and temporary electrical cardiac pacing is 10 mmol/l (determined by ROC curve) and may be used in risk stratification; patients with glucose levels <10 mmol/l on admission are at 3-fold lower risk compared to those with glucose levels >10 mml/l. Our results suggest that SH is a more reliable marker of poor outcome in AMI patients with temporary pace maker, without previously diagnosed DM.

Keywords: acute myocardial infarction, stress hyperglycaemia, temporary electrical cardiac pacing