GFR and fasting glucose level plus TIMI index improves mortality prediction after acute MI.
CHICAGO—Using plasma fasting glucose level and glomerular filtration rate (GFR) in conjunction with the TIMI risk index improves 30-day mortality predictions following acute MI, data show.
The finding comes from a study of 1,385 patients who experienced acute MI (both non-ST segment elevation MI [740 patients] and ST-segment elevation MI [645 patients]) over an 18-month period. Patients were grouped according to glycemic status; 46% had normal fasting plasma glucose and 26% had preexisting diabetes. In addition, 28% of non-diabetic patients had fasting plasma glucose levels greater than 115 mg/dL (stress hyperglycemia [SH]). Median creatinine level was 98 mmol/L; 763 patients had normal renal function as reflected by a glomerular filtration rate (GFR) higher than 60 mL/min per 1.73 m2. Moreover, 491 patients had moderate renal dysfunction (GFR 30-60 mL/min per 1.73 m2), and 134 had severe renal dysfunction (GFR less than 30 mL/min/1.73m2).
The SH group had higher TIMI risk index than patients with normal glucometabolic status or those with diabetes. One-month mortality in the three glycemic groups was 2.8% for the normal group, 7.5% for those with pre-existing diabetes, and 9.7% for those with SH. Worsening renal function was associated with higher TIMI risk index and lower compliance with treatment guidelines, Dr. Schiele said. One-month mortality was 3% for patients with normal renal function, 4% for those with moderate renal dysfunction, and 15% for those with severe renal dysfunction. No relationship was observed between the rate of use of guideline-recommended treatment and glucometabolic status, but renal dysfunction as assessed by GFR was associated with a higher TIMI risk index and lower guideline compliance.
“A less effective treatment regimen cannot explain the higher mortality in the SH group,” said investigator François Schiele, MD, PhD, of the department of cardiology at UniversityHospital Jean-Minjoz in Besançon, France. He presented findings here at the American Heart Association Scientific Sessions 2006. “On the other hand, the higher mortality observed in patients with renal dysfunction was partially explained by less effective treatment from the start.”
Thirty-day mortality remains significantly higher in patients with diabetes, hyperglycemia, and high creatinine levels after adjusting for TIMI risk index and quality of care, Dr. Schiele said.