Mayo Clinic Proceedings Home

Effect of Abnormal Fasting Plasma Glucose Level on All-Cause Mortality in Older Patients With Acute Myocardial Infarction: Results From the Beijing Elderly Acute Myocardial Infarction Study (BEAMIS)


      To assess whether the relationship between abnormal fasting plasma glucose (FPG) levels and patient outcomes holds for both older men and older women with acute myocardial infarction (AMI).


      From April 1, 2004, to October 31, 2006, a total of 2016 consecutive older patients (age ≥65 years) presenting with AMI were screened. Of these patients, 1854 were consecutively enrolled in the study. Patients were categorized into 4 groups: the hypoglycemic group (FPG, ≤90.0 mg/dL [to convert to mmol/L, multiply by 0.0555]; n=443, 23.9%), the euglycemic group (FPG, 90.1-126.0 mg/dL; n=812, 43.8%), the mildly hyperglycemic group (FPG, 126.1-162.0 mg/dL; n=308, 16.6%), and the severely hyperglycemic group (FPG, ≥162.1 mg/dL; n=291, 15.7%). The primary outcomes were rates of in-hospital and 3-year mortality.


      Female patients were older and had a higher incidence of diabetes mellitus but lower rates of smoking and use of invasive therapy. Men tended to have a higher frequency of hypoglycemia, whereas women tended to have a higher frequency of hyperglycemia. No significant difference was found in in-hospital (10.9% vs 9.1%; P=.36) or 3-year (24.5% vs 24.5%; P=.99) mortality between male and female patients, and FPG-associated mortality did not vary significantly by sex.


      An increased FPG level was associated with a relatively higher risk of in-hospital mortality in men but not in women. Nonetheless, increased and decreased FPG levels at admission could predict higher mortality rates regardless of sex. There was a striking U-shaped relationship between FPG levels and in-hospital and 3-year mortality. The effect of abnormal FPG level on outcomes among older patients with AMI did not vary significantly by sex.
      AMI (acute myocardial infarction), BEAMIS (the Beijing Elderly Acute Myocardial Infarction Study), CABG (coronary artery bypass grafting), CI (confidence interval), DM (diabetes mellitus), FPG (fasting plasma glucose), PCI (percutaneous coronary intervention)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cutler JA
        • Sorlie PD
        • Wolz M
        • Thom T
        • Fields LE
        • Roccella EJ
        Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988-1994 and 1999-2004.
        Hypertension. 2008; 52: 818-827
        • Hoerger TJ
        • Segel JE
        • Gregg EW
        • Saaddine JB
        Is glycemic control improving in U.S. adults?.
        Diabetes Care. 2008; 31: 81-86
        • Mann D
        • Reynolds K
        • Smith D
        • Muntner P
        Trends in statin use and low-density lipoprotein cholesterol levels among US adults: impact of the 2001 National Cholesterol Education Program guidelines.
        Ann Pharmacother. 2008; 42: 1208-1215
        • McWilliams JM
        • Meara E
        • Zaslavsky AM
        • Ayanian JZ
        Differences in control of cardiovascular disease and diabetes by race, ethnicity, and education: U.S. trends from 1999 to 2006 and effects of Medicare coverage.
        Ann Intern Med. 2009; 150: 505-515
        • Steinberg BA
        • Bhatt DL
        • Mehta S
        • et al.
        Nine-year trends in achievement of risk factor goals in the US and European outpatients with cardiovascular disease.
        Am Heart J. 2008; 156: 719-727
        • Kannel WB
        • Sorlie P
        • McNamara PM
        Prognosis after initial myocardial infarction: the Framingham study.
        Am J Cardiol. 1979; 44: 53-59
        • Chandra NC
        • Ziegelstein RC
        • Rogers WJ
        • et al.
        Observations of the treatment of women in the United States with myocardial infarction: a report from the National Registry of Myocardial Infarction-I.
        Arch Intern Med. 1998; 158: 981-988
        • Vakili BA
        • Kaplan RC
        • Brown DL
        Sex-based differences in early mortality of patients undergoing primary angioplasty for first acute myocardial infarction.
        Circulation. 2001; 104: 3034-3038
        • Gottlieb S
        • Harpaz D
        • Shotan A
        • Israeli Thrombolytic Survey Group
        • et al.
        Sex differences in management and outcome after acute myocardial infarction in the 1990s: a prospective observational community-based study.
        Circulation. 2000; 102: 2484-2490
        • 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: 773-778
        • Wahab NN
        • Cowden EA
        • Pearce NJ
        • Gardner MJ
        • Merry H
        • Cox JL
        Is blood glucose an independent predictor of mortality in acute myocardial infarction in the thrombolytic era?.
        J Am Coll Cardiol. 2002; 40: 1748-1754
        • Stranders I
        • Diamant M
        • van Gelder RE
        • et al.
        Admission blood glucose level as risk indicator of death after myocardial infarction in patients with and without diabetes mellitus.
        Arch Intern Med. 2004; 164: 982-988
        • Foo K
        • Cooper J
        • Deaner A
        • et al.
        A single serum glucose measurement predicts adverse outcomes across the whole range of acute coronary syndromes.
        Heart. 2003; 89: 512-516
        • Kosiborod M
        • Rathore SS
        • Inzucchi SE
        • et al.
        Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes.
        Circulation. 2005; 111: 3078-3086
        • Iwakura K
        • Ito H
        • Ikushima M
        • et al.
        Association between hyperglycemia and the no-reflow phenomenon in patients with acute myocardial infarction.
        J Am Coll Cardiol. 2003; 41: 1-7
        • Ishihara M
        • Kojima S
        • Sakamoto T
        • Japanese Acute Coronary Syndrome Study (JACSS) Investigators
        • et al.
        Comparison of blood glucose values on admission for acute myocardial infarction in patients with versus without diabetes mellitus.
        Am J Cardiol. 2009; 104: 769-774
        • Dungan K
        • Chapman J
        • Braithwaite SS
        • Buse J
        Glucose measurement: confounding issues in setting targets for inpatient management.
        Diabetes Care. 2007; 30: 403-409
        • Thygesen K
        • Alpert JS
        • White HD
        • Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction
        Universal definition of myocardial infarction.
        Eur Heart J. 2007; 28: 2525-2538
        • Parakh K
        • Thombs BD
        • Bhat U
        • Fauerbach JA
        • Bush DE
        • Ziegelstein RC
        Long-term significance of Killip class and left ventricular systolic dysfunction.
        Am J Med. 2008; 121: 1015-1018
        • Krumholz HM
        • Murillo JE
        • Chen J
        • et al.
        Thrombolytic therapy for eligible elderly patients with acute myocardial infarction.
        JAMA. 1997; 277: 1683-1688
        • Milcent C
        • Dormont B
        • Durand-Zaleski I
        • Steg PG
        Gender differences in hospital mortality and use of percutaneous coronary intervention in acute myocardial infarction: microsimulation analysis of the 1999 nationwide French hospitals database.
        Circulation. 2007; 115: 833-839
        • Hollenbeak CS
        • Weisman CS
        • Rossi M
        • Ettinger SM
        Gender disparities in percutaneous coronary interventions for acute myocardial infarction in Pennsylvania.
        Med Care. 2006; 44: 24-30
        • Hirakawa Y
        • Masuda Y
        • Kuzuya M
        • Iguchi A
        • Kimata T
        • Uemura K
        Impact of gender on in-hospital mortality of patients with acute myocardial infarction undergoing percutaneous coronary intervention: an evaluation of the TAMIS-II data.
        Intern Med. 2007; 46: 363-366
        • Suleiman M
        • Hammerman H
        • Boulos M
        • et al.
        Fasting glucose is an important independent risk factor for 30-day mortality in patients with acute myocardial infarction: a prospective study.
        Circulation. 2005; 111: 754-760
        • Sinnaeve PR
        • Steg PG
        • Fox KA
        • GRACE Investigators
        • et al.
        Association of elevated fasting glucose with increased short-term and 6-month mortality in ST-segment elevation and non-ST-segment elevation acute coronary syndromes: the Global Registry of Acute Coronary Events.
        Arch Intern Med. 2009; 169: 402-409
        • Svensson AM
        • McGuire DK
        • Abrahamsson P
        • Dellborg M
        Association between hyper- and hypoglycaemia and 2 year all-cause mortality risk in diabetic patients with acute coronary events.
        Eur Heart J. 2005; 26: 1255-1261
        • Kosiborod M
        • Inzucchi SE
        • Goyal A
        • et al.
        Relationship between spontaneous and iatrogenic hypoglycemia and mortality in patients hospitalized with acute myocardial infarction.
        JAMA. 2009; 301: 1556-1564
        • Goyal A
        • Mehta SR
        • Díaz R
        • et al.
        Differential clinical outcomes associated with hypoglycemia and hyperglycemia in acute myocardial infarction.
        Circulation. 2009; 120: 2429-2437
        • Mellbin LG
        • Malmberg K
        • Waldenström A
        • Wedel H
        • Rydén L
        • DIGAMI 2 investigators
        Prognostic implications of hypoglycaemic episodes during hospitalisation for myocardial infarction in patients with type 2 diabetes: a report from the DIGAMI 2 trial.
        Heart. 2009; 95: 721-727
        • Oliver MF
        Metabolic causes and prevention of ventricular fibrillation during acute coronary syndromes.
        Am J Med. 2002; 112: 305-311
        • Scognamiglio R
        • Negut C
        • De Kreutzenberg SV
        • Tiengo A
        • Avogaro A
        Postprandial myocardial perfusion in healthy subjects and in type 2 diabetic patients.
        Circulation. 2005; 112: 179-184
        • Gresele P
        • Guglielmini G
        • De Angelis M
        • et al.
        Acute, short-term hyperglycemia enhances shear stress-induced platelet activation in patients with type II diabetes mellitus.
        J Am Coll Cardiol. 2003; 41: 1013-1020
        • Aljada A
        • Friedman J
        • Ghanim H
        • et al.
        Glucose ingestion induces an increase in intranuclear nuclear factor kappa B, a fall in cellular inhibitor kappa B, and an increase in tumor necrosis factor alpha messenger RNA by mononuclear cells in healthy human subjects.
        Metabolism. 2006; 55: 1177-1185
        • Kawano H
        • Motoyama T
        • Hirashima O
        • et al.
        Hyperglycemia rapidly suppresses flow-mediated endothelium-dependent vasodilation of brachial artery.
        J Am Coll Cardiol. 1999; 34: 146-154
        • Mohanty P
        • Hamouda W
        • Garg R
        • Aljada A
        • Ghanim H
        • Dandona P
        Glucose challenge stimulates reactive oxygen species (ROS) generation by leucocytes.
        J Clin Endocrinol Metab. 2000; 85: 2970-2973
        • Galassetti P
        • Davis SN
        Effects of insulin per se on neuroendocrine and metabolic counter-regulatory responses to hypoglycaemia.
        Clin Sci (Lond). 2000; 99: 351-362
        • Heller SR
        Abnormalities of the electrocardiogram during hypoglycaemia: the cause of the dead in bed syndrome?.
        Int J Clin Pract Suppl. 2002; 129: 27-32