Impact of hyperglycemia in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: the HORIZONS-AMI trial

Background: Few studies have examined the association between hyperglycemia and adverse outcomes in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). We therefore evaluated the prognostic utility of admission hyperglycemia in the HORIZONS-AMI trial.

Methods and results: Admission glucose levels were available in 3405 of 3602 (94.5%) enrolled patients, of which 566 patients (16.6%) were known to have diabetes. Outcomes were assessed at 30 days and 3 years, stratified by baseline glucose level and diabetes status. Median [IQR] admission glucose level in the entire study cohort was 138.0 [115.4, 171.0] mg/dl. Multivariable adjusted 30-day mortality was significantly increased in all patients with admission glucose in the highest glucose tertile vs. the lower two-thirds (HR [95%CI]=3.53 [1.89, 6.60], p<0.0001); in patients with diabetes (4.40 [2.04, 9.50], p=0.0002); and in patients without diabetes (3.33 [1.16, 9.55], p=0.03). By ROC analysis, the best cut-off values for 30-day mortality were 169 mg/dl for all patients (AUC=0.76), 149 mg/dl for patients without diabetes (AUC=0.77), and 231 mg/dl for patients with diabetes (AUC=0.69). Baseline hyperglycemia was also an independent predictor of 3-year mortality in all patients (HR [95%CI]=1.93 [1.35, 2.76], P=0.0003), patients with diabetes (2.65 [1.28, 5.47], P=0.008), and patients without diabetes (1.58 [1.05, 2.36], P=0.03).

Conclusions: In patients with STEMI undergoing primary PCI, admission hyperglycemia is an independent predictor of early and late mortality in both patients with and without known diabetes.