Abstract:
Objective: To investigate the incidence of stress hyperglycaemia at first acute
myocardial infarction (MI) with ST-segment elevation, occurrence of stress hyperglycaemia
as a manifestation of previously undiagnosed abnormal glucose tolerance
(AGT), and its relation to stress hormone levels. Materials and
methods: The population of this prospective cohort study consisted of 243
patients. On admission glucose, adrenaline, noradrenaline and cortisol levels were
measured. Patients without previously diagnosed diabetes (n = 204) underwent an
oral glucose tolerance test on day 3 of hospitalisation and 3 months after discharge.
Results: Abnormal glucose tolerance at day 3 was observed in 92
(45.1%) patients without a previous diagnosis of diabetes mellitus and resolved
after 3 months in 46 (50.0%) patients (p < 0.0001). Stress hyperglycaemia,
defined as admission glycaemia ‡ 11.1 mmol ⁄ l, affected 34 (14.0%) study participants:
28 (54.9%) patients with diabetes vs. 3 (8.8%) subjects with newly
detected impaired glucose intolerance (p < 0.00001) and 1 (2.2%) person with
AGT at day 3 (p < 0.000001). Multivariable analysis identified elevated glycated
haemoglobin (HbA1c; p < 0.0000001), anterior MI (p < 0.05) and high admission
cortisol concentration (p < 0.001), but not catecholamines, as independent predictors
of stress hyperglycaemia. The receiver operating characteristic curve analysis
revealed the optimal cut-off values of 8.2% for HbA1c and 47.7 lg ⁄ dl for admission
cortisol with very good and sufficient diagnostic accuracies respectively. Conclusions:
Newly detected AGT in patients with a first MI is transient in 50% of
cases. Stress hyperglycaemia is a common finding in patients with a first MI with
ST-segment elevation and diabetes mellitus, but is rarely observed in individuals
with impaired glucose tolerance or transient AGT diagnosed during the acute
phase of MI. The risk factors of stress hyperglycaemia occurrence include elevated
HbA1c, anterior MI and high admission cortisol concentration.