The retrospective study by Stranders et al1 describing the relationship of elevated admission blood glucose levels (>200 mg/dL [>11.1 mmol/L]) in nondiabetic patients with acute myocardial infarction (AMI) and mortality is a useful addition to the literature on risk stratification in AMI. There are several points in this article that we would like to bring to the attention of the readers. First, in the study population, approximately 50% received thrombolytic or primary angioplasty and the remainder were managed conservatively, yet the in-hospital mortality of 2.5%, 7.1%, 6.9%, and 4.6%, respectively, in groups 1 through 4 is superior to that of most trials that managed with more aggressive strategies.2 This finding would be unusual in a population of patients that had the number of in-hospital events as the study population. It would also have been helpful if the authors’ analyses considered additional factors that are known to be associated with short- and long-term outcomes, such as Killip class, systolic blood pressure, heart rate, and medication administration (eg, β-blocker, angiotensin-converting enzyme inhibitors, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, and aspirin). Finally, if admission blood glucose level is truly an independent predictor of mortality in AMI, further studies regarding admission blood glucose level and outcomes for AMI will need to be performed because the management of AMI has evolved so rapidly in the recent past.
Bobba RK, Arsura EL. Blood Glucose Level as a Risk Indicator of Death After Acute Myocardial Infarction. Arch Intern Med. 2004;164(22):2500–2509. doi:10.1001/archinte.164.22.2500-b