Objective The aim of this study was to assess whether the admission FPG levels were associated with all-cause mortality and left ventricular (LV) function in older patients with acute myocardial (AMI) by analysing data from the Beijing Elderly Acute Myocardial Infarction Study (BEAMIS).
Methods From April 2004 to October 2006, 1854 older (age ≥65 years) AMI patients were consecutively enrolled in BEAMIS Patients were categorised into 4 groups: hypoglycemia group (N=443, 23.9%), FPG≤5 mmol/l; euglycemia group (N=812, 43.8%), 5.1 mmol/L≤FPG≤7 mmol/l (5–7 mmol/l); mild hyperglycemia group (N=308, 16.6%), 7.1 mmol/L≤FPG≤9 mmol/l (7–9 mmol/l); and severe hyperglycemia group (N=291, 15.7%), FPG≥9.1 mmol/l. The primary outcomes were in-hospital and 3-year mortality and LV function during admission.
Results There was a near-linear relationship between FPG levels and Killip class, with Killip classes I/II and III/IV being more frequent among patients with hypoglycemia and hyperglycemia, respectively (p=0.011). However, no significant correlation was found between admission FPG levels and LVEF, LV end-diastolic or end-systolic diameter (p=0.837, 0.073, 0.165, respectively). Both admission FPG levels (p=0.002) and Killip classes (p<0.001) were all independent significant predictors for in-hospital/3-year mortality. Compared with the euglycemia group, both the hypo- and hyperglycemia groups were associated with higher in-hospital and 3-year all-cause mortality. Patients in the FPG 5–7 mmol/l group had the best outcome. In-hospital mortality of patients with hypoglycemia and Killip class IV was the highest in the overall cohort, followed by that of patients with severe hyperglycemia and Killip class IV (60% vs 50.0%, p=0.015). In contrast, 3-year mortality of patients with severe hyperglycemia and Killip class IV was highest followed by that of patients with hypoglycemia and Killip class IV (70% vs 60.0%, p=0.001).
Conclusions In older patients with AMI, abnormal FPG values had differential influences on LV function and mortality. Not only increased but also decreased admission FPG levels could predict in-hospital and 3-year mortality. There was a U-shaped relationship between admission FPG levels and short- or long-term mortality, and a near-linear relationship between increased admission glucose levels and higher Killip classification.