AUTHOR=Humos Basel , Mahfoud Ziyad , Dargham Soha , Al Suwaidi Jassim , Jneid Hani , Abi Khalil Charbel 

TITLE=Hypoglycemia is associated with a higher risk of mortality and arrhythmias in ST-elevation myocardial infarction, irrespective of diabetes

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.940035

DOI=10.3389/fcvm.2022.940035

ISSN=2297-055X

ABSTRACT=Aims: We aimed to assess the impact of hypoglycemia in ST-elevation myocardial infarction (STEMI). 

Background: Hypoglycemia increases mortality risk in patients with diabetes and high cardiovascular risk. 

Methods:  We used the National Inpatient Sample (2005-2017) database to identify adult patients with STEMI as the primary diagnosis. The secondary diagnosis was hypoglycemia. We compared cardiovascular and socio-economic outcomes between STEMI patients with and without hypoglycemia and assessed temporal trends.

Results: Hypoglycemia complicates 0.17% of all cases hospitalized for STEMI. The mean age (±SD) of STEMI patients hospitalized with hypoglycemia decreased from 67 ±15 in 2005 to 63 ±12 in 2017 (p=0.046). Mortality was stable with time, but the prevalence of ventricular tachycardia, ventricular fibrillation, acute renal failure, cardiogenic shock, total charges, and length of stay (LOS) increased with time (p<0.05 for all). Compared to non-hypoglycemic patients, those who developed hypoglycemia were older and more likely to be African Americans; only 6.7% had diabetes compared to 28.5% of STEMI patients (p=0.001). Cardiovascular events were more likely to occur in hypoglycemia (Table 3). Mortality risk increased by almost 4-fold and remained high after multivariable adjustment (adjusted OR=2.625 [2.095 - 3.289], p<0.001). There was a higher incidence of cardiogenic shock (adjusted OR=1.718 [1.387 – 2.127]), p<0.001), atrial fibrillation (adjusted OR=1.284 [1.025 - 1.607], p=0.03), ventricular fibrillation (adjusted OR= 1.799 [1.406 - 2.301], p=0.001), and acute renal failure (adjusted OR=2.355 [1.902 - 2.917], p<0.001). Patients with STEMI and diabetes were less likely to have PCI (OR=0.596 [0.491 - 0.722)], p<0.001) but more likely to have CABG (OR=1.792 [1.391 - 2.308], p<0.001). They also had a longer in-hospital stay and higher charges/stay. 

Conclusion:  Hypoglycemia is a rare event in patients hospitalized with STEMI. However, it was found to have higher odds of mortality, arrhythmias, and other comorbidities, irrespective of diabetes.