Diabetes Mellitus and Stress Hyperglycemia

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Diabetes mellitus increases the relative risk of in-hospital mortality by at least 1.5-2 compared with nondiabetic patients (15). Diabetic women in particular have a relatively poor prognosis, in part related to an increased incidence of congestive heart failure, rein-farction, and recurrent ischemic events (15-18). Late mortality is significantly increased in diabetic compared with nondiabetic patients (19).

Stress hyperglycemia at the time of MI is strongly correlated with mortality rates. In a meta-analysis conducted by Capes et al. (20), data from 15 trials reporting admission glucose concentrations in relation to in-hospital mortality or heart failure rates after AMI were reviewed. In the patients without known diabetes, those with a glucose concentration >109-143 mg/dL had a 3.9-fold higher risk of death compared to patients with lower glucose concentrations. At glucose concentrations of > 143-180 mg/dL, the risk of cardiogenic shock or heart failure was increased 3-fold. In patients with frank diabetes, glucose concentrations >180-196 mg/dL were associated with a moderate risk of death (relative risk 1.7).

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