Effect of Stress Hyperglycemia in Acute St Segment Elevation Myocardial Infarction

Background Stress hyperglycemia, after an acute myocardial infarction may be associated with increased risk of heart failure, cardiogenic shock, and death. Objectives · To study the effect of stress hyperglycemia, on the development of cardiogenic shock, heart failure, arrhythmia and death · To determine, whether the site of myocardial infarction has an effect on development of stress hyperglycemia · To determine, whether this hyperglycemia occurs more in patients, who receive thrombolytic therapy or in those who do not receive it. Patients and methods This study had enrolled 92 patients, with acute ST elevation myocardial infarction, who had no history of diabetes or heart failure, who were consecutively admitted to ( emergency department then to CCU and medical ward ) in Baghdad Teaching Hospital, during the period of one year between 1stof December, 2011 to 1st of December, 2012. All of the patients had been thouroghly examined and sent for random plasma glucose and HbA1c; in addition ECG, cTn and echo cardiographic examination had been made, for all of them. Statistical analysis had been done, using student's T-test and Chi square test, according to the type of data to analyse. P value <0.05 had been selected as level of statistically significant association or difference. Results A total number of 92 patients were studied; Group 1: 60 patients (60%) were normoglycemics, along their hospital admission. Group 2: 32 patients(32%) were hyperglycemics, due to myocardial infarction induced stress. 8 patients (8%) were excluded from the study because, their HbA1c was elevated (they were considered undiagnosed DM). The incidence of heart failure, cardiogenic shock and death were high in group 2. While, the incidence of cardiac arrhythmias is not significantly differed between group 1 and group 2 patients. Extensive myocardial infarction occurred more frequent in group 2 patients. Conclusions · Stress hyperglycemia, is independently a poor prognostic factor in acute ST elevation myocardial infarction; it is independently associated with increased incidence of heart failure, cardiogenic shock and death. · Patients with extensive myocardial infarction are more liable, to get stress hyperglycemia. · Stress hyperglycemia is not associated with increased incidence of cardiac arrhythmia. · Stress hyperglycemia occurs more in patients, who receive thrombolytic therapy