Q: Which of the following can have a predictive value in acute myocardial infarction (AMI)?
A) Glucose
B) Sodium
C) Potassium
D) Calcium
E) Creatinine
Answer: A
In patients who don't have diabetes, and have glucose concentrations between 110 and 143 mg/dL at presentation with AMI have a 3.9-fold higher risk of death in comparison to patients with lower glucose concentrations. Moreover, glucose values between 144 and 180 mg/dL have a three-fold higher risk of some degree of cardiogenic shock.
Diabetic patients with glucose concentrations more or equal to 180 to 196 mg/dL have a higher risk of death compared with diabetic patients having normal or lower glucose level.
References:
1. Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet 2000; 355:773.
2. Malmberg K, Norhammar A, Wedel H, Rydén L. Glycometabolic state at admission: important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction: long-term results from the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study. Circulation 1999; 99:2626.
3. Goyal A, Mehta SR, Díaz R, et al. Differential clinical outcomes associated with hypoglycemia and hyperglycemia in acute myocardial infarction. Circulation 2009; 120:2429.
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