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(Circulation. 2007;115:e436-e439.)
© 2007 American Heart Association, Inc.

Clinician Update

Implications and Treatment of Acute Hyperglycemia in the Setting of Acute Myocardial Infarction

Stuart W. Zarich, MD; Richard W. Nesto, MD

From the Division of Cardiovascular Medicine, Bridgeport Hospital, Yale University School of Medicine, New Haven, Conn (S.W.Z.), and Department of Cardiovascular Medicine, Lahey Clinic Medical Center, Harvard Medical School, Burlington, Mass (R.W.N.).

Correspondence to Richard W. Nesto, MD, Lahey Clinic Medical Center, 41 Mall Rd, Burlington, MA 01805. E-mail richard.w.nesto@lahey.org

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
A 52-year-old obese male without a prior history of diabetes mellitus (DM) presented with angina and an anterior ST-segment–elevation myocardial infarction (STEMI). Physical examination and chest x-ray were consistent with congestive heart failure. Admission glucose was 230 mg/dL. Coronary angiography revealed an occluded left anterior descending coronary artery, and stenting reestablished TIMI grade 2 flow in that artery within 90 minutes of symptom onset. Left ventricular ejection fraction was 35% with severe anterior hypokinesis. Peak creatine kinase was 600 IU. The next day, fasting glucose was 180 mg/dL. An echocardiogram performed 6 weeks after discharge revealed an ejection fraction of 35% without change in the anterior wall motion. Fasting glucose as an outpatient was 156 mg/dL.

The scenario described above is commonly encountered and illustrates how hyperglycemia can affect the outcome of patients with STEMI. Hyperglycemia could have affected the following features of this case: (1) Congestive heart failure was present despite only modest myocardial injury by creatine kinase level; (2) despite successful percutaneous coronary intervention, subnormal coronary perfusion was observed; and (3) left ventricular recovery after STEMI did not occur. Cardiologists need to be cognizant of the hazards associated with hyperglycemia in this setting because these patients will be encountered more frequently as a result of the increasing prevalence of insulin resistance syndromes.

	Prevalence and Risk of Hyperglycemia in STEMI

 
Acute hyperglycemia is common in patients with STEMI even in the absence of a history of type 2 DM. Hyperglycemia is encountered in up to 50% of all STEMI patients, whereas previously diagnosed DM is present . . . [Full Text of this Article]

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