Stress hyperglycaemia in patients with first myocardial infarction

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dc.contributor.author Bronisz, Agata
dc.contributor.author Koziński, Marek
dc.contributor.author Magielski, Przemysław
dc.contributor.author Fabiszak, Tomasz
dc.contributor.author Bronisz, Marek
dc.contributor.author Świątkiewicz, Iwona
dc.contributor.author Sukiennik, Adam
dc.contributor.author Beszczyńska, Beata
dc.contributor.author Junik, Roman
dc.contributor.author Kubica, Jacek
dc.date.accessioned 2013-02-22T07:22:18Z
dc.date.available 2013-02-22T07:22:18Z
dc.date.issued 2012
dc.identifier.citation International Journal of Clinical Practice vol. 66 (6), 2012, pp. 592-601
dc.identifier.issn 1742-1241
dc.identifier.uri http://repozytorium.umk.pl/handle/item/380
dc.description.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.
dc.language.iso eng
dc.publisher Blackwell Publishing
dc.rights info:eu-repo/semantics/openAccess
dc.subject Stress hyperglycaemia
dc.subject first myocardial infarction
dc.subject myocardial infarction
dc.subject hyperglycaemia
dc.title Stress hyperglycaemia in patients with first myocardial infarction
dc.type info:eu-repo/semantics/article

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