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.