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Clinical Research in Cardiology

, Volume 107, Issue 6, pp 517–523 | Cite as

Revision: prognostic impact of baseline glucose levels in acute myocardial infarction complicated by cardiogenic shock—a substudy of the IABP-SHOCK II-trial

  • Amr Abdin
  • Janine Pöss
  • Georg Fuernau
  • Taoufik Ouarrak
  • Steffen Desch
  • Ingo Eitel
  • Suzanne de Waha
  • Uwe Zeymer
  • Michael Böhm
  • Holger Thiele
Original Paper

Abstract

Background

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.

Conclusions

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.

Keywords

Cardiogenic shock Acute myocardial infarction Blood glucose Hyperglycemia Prognosis 

Notes

Compliance with ethical standards

Conflict of interest

All authors declared that they have no competing interest.

References

  1. 1.
    Deane AM, Horowitz M (2013) Dysglycaemia in the critically ill—significance and management. Diabetes Obes Metab 15:792–801CrossRefPubMedGoogle Scholar
  2. 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
  3. 3.
    Marik PE, Bellomo R (2013) Stress hyperglycemia: an essential survival response! Crit Care 17:305–307CrossRefPubMedPubMedCentralGoogle Scholar
  4. 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
  5. 5.
    Falciglia M, Freyberg RW, Almenoff PL, D’Alessio DA, Render ML (2009) Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis. Crit Care Med 37:3001–3009CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Capes SE, Hunt D, Malmberg K, Gerstein HC (2000) Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet 355:773–778CrossRefPubMedGoogle Scholar
  7. 7.
    Reynolds HR, Hochman JS (2008) Cardiogenic shock: current concepts and improving outcomes. Circulation 117:686–697CrossRefPubMedGoogle Scholar
  8. 8.
    Thiele H, Ohman E, Desch S, Eitel I, deWaha S (2015) Management of cardiogenic shock. Eur Heart J 36:1223–1230CrossRefPubMedGoogle Scholar
  9. 9.
    Link A, Pöss J, Rbah R, Barth C, Feth L, Selejan S, Böhm M (2013) Circulating angiopoietins and cardiovascular mortality in cardiogenic shock. Eur Heart J 34:1651–1662CrossRefPubMedGoogle Scholar
  10. 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. 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. 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. 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
  14. 14.
    Boudina S, Abel ED (2007) Diabetic cardiomyopathy revisited. Circulation 115:3213–3223CrossRefPubMedGoogle Scholar
  15. 15.
    Sud M, Wang X, Austin PC, Lipscombe LL, Newton GE, Tu JV, Vasan RS, Lee DS (2015) Presentation blood glucose and death, hospitalization, and future diabetes risk in patients with acute heart failure syndromes. Eur Heart J 36:924–931CrossRefPubMedGoogle Scholar
  16. 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. 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. 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
  19. 19.
    Pöss J, Köster J, Fuernau G, Eitel I, de Waha S, Ouarrak T, Lassus J, Harjola VP, Zeymer U, Thiele H, Desch S (2017) Risk stratification for patients in cardiogenic shock after acute myocardial infarction. J Am Coll Cardiol 69:1913–1920CrossRefPubMedGoogle Scholar
  20. 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

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Amr Abdin
    • 1
  • Janine Pöss
    • 1
    • 2
  • Georg Fuernau
    • 1
    • 2
  • Taoufik Ouarrak
    • 3
  • Steffen Desch
    • 6
  • Ingo Eitel
    • 1
    • 2
  • Suzanne de Waha
    • 1
    • 2
  • Uwe Zeymer
    • 4
  • Michael Böhm
    • 5
  • Holger Thiele
    • 6
  1. 1.Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine)University Heart Centre LuebeckLuebeckGermany
  2. 2.German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/LuebeckLuebeckGermany
  3. 3.Institut für HerzinfarktforschungLudwigshafenGermany
  4. 4.Klinikum Ludwigshafen and Institut für Herzinfarktforschung LudwigshafenLudwigshafenGermany
  5. 5.Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische IntensivmedizinUniversitätsklinikum des SaarlandesHomburg/SaarGermany
  6. 6.Department of Internal Medicine/CardiologyUniversity of Leipzig-Heart Centre LeipzigLeipzigGermany

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