Glucose Normalization and Outcomes in Patients With Acute ...

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Glucose Normalization and Outcomes in Patients With Acute Myocardial Infarction

Mikhail Kosiborod, MD; Silvio E. Inzucchi, MD; Harlan M. Krumholz, MD, SM; Frederick A. Masoudi, MD, MSPH; Abhinav Goyal, MD, MHS; Lan Xiao, PhD; Philip G. Jones, MS; Suzanne Fiske, MS; John A. Spertus, MD, MPH

Arch Intern Med. 2009;169(5):438-446.

Background Elevated blood glucose levels on admission are associated with increased mortality in patients with acute myocardial infarction. Whether glucose normalization after admission is associated with improved survival remains controversial. In addition, whether outcomes differ in patients who have spontaneous resolution of hyperglycemia vs those who achieve normoglycemia after treatment with insulin is also unknown.

Methods We studied 7820 hyperglycemic (admission glucose level, 140 mg/dL to convert glucose to millimoles per liter, multiply by 0.0555 ) patients with acute myocardial infarction hospitalized between January 1, 2000, and December 31, 2005, in 40 US hospitals. Patients were stratified according to their mean glucose levels after admission and were divided into those who did and did not receive insulin therapy. Multivariable logistic regression models were developed to examine whether lower glucose levels after admission are independently associated with better survival. Propensity-matching methods were then used to compare in-hospital mortality in patients who did and did not receive insulin therapy.

Results After multivariable adjustment, lower mean postadmission glucose levels were associated with better survival (for mean postadmission glucose levels of 110 to

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