Hyperglycemia (HG) has been shown to be a powerful predictor of worse outcome after ST segment-elevation myocardial infarction (STEMI).

Investigate the relationship between acute HG and angiographic and clinical outcome after primary or rescue angioplasty for STEMI.

We retrospectively included 489 patients who underwent revascularization for STEMI. We compared hospital outcomes of patients with HG (HG+) with those without HG (HG−) and outcomes of diabetic with non-diabetic patients in the HG+ group. Plasma glucose was measured at hospital admission. HG was defined as plasma glucose>11mmol/L (198mg/dL).

Among the overall population, 184 (37.6%) patients had HG. Procedural success was significantly lower in the HG+ group (86% vs. 92%, P=0.05) with lower rates of ST segment resolution at 24hours (47.3% vs. 61.4%, P=0.006). Hospital outcomes were worse in the HG+ group with a higher mortality (20% vs. 10.4%, P=0.008). Predictive factors for intrahospital mortality in the overall cohort were: procedural failure (OR: 4.76; 95% CI [1.65–13.7]; P=0.004), heart failure at admission (OR: 9.75; 95% CI [4.14–22.87]; P<0.001), anemia (OR: 4.22; 95% CI [2.06–8.63]; P<0.001), high serum creatinine level (OR: 1.09; 95% CI [1.03–1.14]; P=0.001), high glycemia (OR: 2.66; 95% CI [1.2–5.9]; P=0.016). Diabetes did not predict hospital mortality (P=0.64) even in the group of patients with hyperglycemia. In non-diabetic patients (n=260), HG was associated with larger infarct size (P=0.001) and more adverse outcome (P=0.009). In the same group, HbA_1c was associated with one year mortality (P=0.02).

In patients with STEMI, HG is an important predictor of worse outcomes with an increased mortality risk even beyond 11mmol/L. In non-diabetic patients, both elevated glucose and HbA1c levels were associated with adverse outcomes.