Pinto DS et al. (2008) Association of blood glucose with angiographic and clinical outcomes among patients with ST-segment elevation myocardial infarction (from the CLARITY-TIMI-28 study). Am J Cardiol 101: 303–307

Hyperglycemia is associated with adverse outcomes in patients with acute coronary syndromes, possibly as a result of the adverse effect of hyperglycemia on platelet function. Pinto and co-workers conducted retrospective analyses of data from the Clopidogrel as Adjunctive Reperfusion Therapy–Thrombolysis In Myocardial Infarction 28 (CLARITY–TIMI 28) study to examine the association between serum glucose level and angiographic outcomes in patients with ST-segment elevation myocardial infarction who underwent fibrinolytic therapy.

In the trial, 3,491 individuals were divided into six groups on the basis of their blood glucose level on admission. Patients underwent angiography between 48 h and 192 h after initiation of treatment with either clopidogrel plus standard fibrinolytic therapy or standard therapy only. Multivariate analysis showed that, compared with patients with euglycemia, patients with hyperglycemia (glucose level ≥5.6 mmol/l (100 mg/dl) had an almost twofold increase in the risk of the combined end point of an occluded infarct-related artery, death before angiography, or recurrent myocardial infarction before angiography (for the two highest sextiles of glucose level, >11.0 mmol/l [199 mg/dl] and 8.4–11.0 mmol/l [151–199 mg/dl], the odds ratios were 1.94 and 2.29, respectively). This association remained substantial regardless of clopidogrel administration or history of diabetes mellitus. In addition, even moderate increases in glucose level were associated with stepwise increases in adverse event rates, independent of clopidogrel administration.

These data highlight the need to identify patients with hyperglycemia, who are at high risk of adverse angiographic outcomes regardless of a history of diabetes.