Georg Sabin

OMEGA, a Randomized, Placebo-Controlled Trial to Test the Effect of Highly Purified Omega-3 Fatty Acids on Top of Modern Guideline-Adjusted Therapy After Myocardial Infarction

Background— There is no randomized, double-blind trial testing the prognostic effect of highly purified omega-3 fatty acids in addition to current guideline-adjusted treatment of acute myocardial infarction. Methods and Results— OMEGA is a randomized, placebo-controlled, double-blind, multicenter trial testing the effects of omega-3-acid ethyl esters-90 (1 g/d for 1 year) on the rate of sudden cardiac death in survivors of acute myocardial infarction, if given in addition to current guideline-adjusted treatment. Secondary end points were total mortality and nonfatal clinical events. Patients (n=3851; female, 25.6%; mean age, 64.0 years) were randomized in 104 German centers 3 to 14 days after acute myocardial infarction from October 2003 until June 2007. Acute coronary angiography was performed in 93.8% and acute percutaneous coronary intervention in 77.8% of all patients. During a follow-up of 365 days, the event rates were (omega and control groups) as follows: sudden cardiac death, 1.5% and 1.5% (P=0.84); total mortality, 4.6% and 3.7% (P=0.18); major adverse cerebrovascular and cardiovascular events, 10.4% and 8.8% (P=0.1); and revascularization in survivors, 27.6% and 29.1% (P=0.34). Conclusions— Guideline-adjusted treatment of acute myocardial infarction results in a low rate of sudden cardiac death and other clinical events within 1 year of follow-up, which could not be shown to be further reduced by the application of omega-3 fatty acids. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00251134.

Myocardial scar visualized by cardiovascular magnetic resonance imaging predicts major adverse events in patients with hypertrophic cardiomyopathy.

OBJECTIVES We sought to establish the prognostic value of a comprehensive cardiovascular magnetic resonance (CMR) examination in risk stratification of hypertrophic cardiomyopathy (HCM) patients. BACKGROUND With annual mortality rates ranging between 1% and 5%, depending on patient selection, a small but significant number of HCM patients are at risk for an adverse event. Therefore, the identification of and prophylactic therapy (i.e., defibrillator placement) in patients with HCM who are at risk of dying are imperative. METHODS Two-hundred forty-three consecutive patients with HCM were prospectively enrolled. All patients underwent initial CMR, and 220 were available for clinical follow-up. The mean follow-up time was 1,090 days after CMR. End points were all-cause and cardiac mortality. RESULTS During follow-up 20 of the 220 patients died, and 2 patients survived sudden cardiac death due to adequate implantable cardioverter-defibrillator discharge. Most events (n = 16) occurred for cardiac reasons; the remaining 6 events were related to cancer and accidents. Our data indicate that the presence of scar visualized by CMR yields an odds ratio of 5.47 for all-cause mortality and of 8.01 for cardiac mortality. This might be superior to classic clinical risk factors, because in our dataset the presence of 2 risk factors yields an odds ratio of 3.86 for all-cause and of 2.20 for cardiac mortality, respectively. Multivariable analysis also revealed the presence of late gadolinium enhancement as a good independent predictor of death in HCM patients. CONCLUSIONS Among our population of largely low or asymptomatic HCM patients, the presence of scar indicated by CMR is a good independent predictor of all-cause and cardiac mortality.

EuroCMR (European Cardiovascular Magnetic Resonance) Registry: Results of the German Pilot Phase

OBJECTIVES During its German pilot phase, the EuroCMR (European Cardiovascular Magnetic Resonance) registry sought to evaluate indications, image quality, safety, and impact on patient management of routine CMR. BACKGROUND CMR has a broad range of applications and is increasingly used in clinical practice. METHODS This was a multicenter registry with consecutive enrollment of patients in 20 German centers. RESULTS A total of 11,040 consecutive patients were enrolled. Eighty-eight percent of patients received gadolinium-based contrast agents. Twenty-one percent underwent adenosine perfusion, and 11% high-dose dobutamine-stress CMR. The most important indications were workup of myocarditis/cardiomyopathies (32%), risk stratification in suspected coronary artery disease/ischemia (31%), as well as assessment of viability (15%). Image quality was good in 90.1%, moderate in 8.1%, and inadequate in 1.8% of cases. Severe complications occurred in 0.05%, and were all associated with stress testing. No patient died during or due to CMR. In nearly two-thirds of patients, CMR findings impacted patient management. Importantly, in 16% of cases the final diagnosis based on CMR was different from the diagnosis before CMR, leading to a complete change in management. In more than 86% of cases, CMR was capable of satisfying all imaging needs so that no further imaging was required. CONCLUSIONS CMR is frequently performed in clinical practice in many participating centers. The most important indications are workup of myocarditis/cardiomyopathies, risk stratification in suspected coronary artery disease/ischemia, and assessment of viability. CMR imaging as used in the centers of the pilot registry is a safe procedure, has diagnostic image quality in 98% of cases, and its results have strong impact on patient management.

European cardiovascular magnetic resonance (EuroCMR) registry – multi national results from 57 centers in 15 countries

BackgroundThe EuroCMR registry sought to evaluate indications, image quality, safety and impact on patient management of clinical routine CMR in a multi-national European setting. Furthermore, interim analysis of the specific protocols should underscore the prognostic potential of CMR.MethodsMulti-center registry with consecutive enrolment of patients in 57 centers in 15 countries. More than 27000 consecutive patients were enrolled.ResultsThe most important indications were risk stratification in suspected CAD/Ischemia (34.2%), workup of myocarditis/cardiomyopathies (32.2%), as well as assessment of viability (14.6%). Image quality was diagnostic in more than 98% of cases. Severe complications occurred in 0.026%, always associated with stress testing. No patient died during or due to CMR. In 61.8% CMR findings impacted on patient management. Importantly, in nearly 8.7% the final diagnosis based on CMR was different to the diagnosis before CMR, leading to a complete change in management. Interim analysis of suspected CAD and risk stratification in HCM specific protocols revealed a low rate of adverse events for suspected CAD patients with normal stress CMR (1.0% per year), and for HCM patients without LGE (2.7% per year).ConclusionThe most important indications in Europe are risk stratification in suspected CAD/Ischemia, work-up of myocarditis and cardiomyopathies, as well as assessment of viability. CMR imaging is a safe procedure, has diagnostic image quality in more than 98% of cases, and its results have strong impact on patient management. Interim analyses of the specific protocols underscore the prognostic value of clinical routine CMR in CAD and HCM.Condensed abstractThe EuroCMR registry sought to evaluate indications, image quality, safety and impact on patient management of clinical routine CMR in a multi-national European setting in a large number of cases (n > 27000). Based on our data CMR is frequently performed in European daily clinical routine. The most important indications in Europe are risk stratification in suspected CAD/Ischemia, work-up of myocarditis and cardiomyopathies, as well as assessment of viability. CMR imaging is a safe procedure, has diagnostic image quality in more than 98% of cases, and its results have strong impact on patient management. Interim analyses of the specific protocols underscore the prognostic value of clinical routine CMR in CAD and HCM.

Right Ventricular Involvement in Acute Left Ventricular Myocardial Infarction: Prognostic Implications of MRI Findings

OBJECTIVE The purpose of this study was to investigate the prevalence and prognostic importance of the cardiac MRI finding of right ventricular involvement in patients with acute ST-segment elevation myocardial infarction (MI). SUBJECTS AND METHODS Fifty patients (41 men, nine women; mean age, 58 +/- 11 years) with first-ST-segment elevation MI underwent 1.5-T cardiac MRI immediately after successful percutaneous coronary intervention. The cardiac MRI protocol included steady-state free precession cine sequences for functional assessment of the left, right, and both ventricles and inversion recovery FLASH delayed enhancement sequences after contrast administration for the quantification of myocardial damage. The prevalence of right ventricular involvement detected with ECG and echocardiography was compared with the prevalence detected with cardiac MRI, which was the reference standard. Patients underwent follow-up for 32 +/- 8 months. RESULTS Right ventricular involvement was diagnosed with cardiac MRI in 27 patients (54%): 14 of 30 patients (47%) with inferior ST-segment elevation MI and 13 of 20 patients (65%) with anterior ST-segment elevation MI. ECG and echocardiographic findings showed only moderate agreement with cardiac MRI findings in the detection of right ventricular involvement in inferior acute MI (kappa = 0.38). Patients with right ventricular involvement in anterior ST-segment elevation MI had larger infarcts (delayed enhancement, 25.9% +/- 14.5% vs 11.4% +/- 10.1%; p = 0.030), lower left ventricular ejection fraction (34.3% +/- 8.2% vs 45.2% +/- 9.5%; p < 0.015), and lower right ventricular ejection fraction (39.8% +/- 6.6% vs 54.9% +/- 8.8%; p < 0.001) than those without right ventricular involvement. In a multivariate logistic regression model, right ventricular involvement was a strong independent predictor (odds ratio, 15.8; 95% CI, 4-63%) of major cardiac adverse events. CONCLUSION Right ventricular involvement in ST-segment elevation MI is detected more frequently with cardiac MRI than with ECG and echocardiography and is an independent prognostic indicator.

Prognostic impact of contrast-enhanced CMR early after acute ST segment elevation myocardial infarction (STEMI) in a regional STEMI network: results of the "Herzinfarktverbund Essen".

Background and Purpose:In acute ST segment elevation myocardial infarction (STEMI), rapid restoration of epicardial coronary blood flow and myocardial perfusion limits infarct size and improves survival. Primary percutaneous coronary intervention (PCI) is superior to systemic fibrinolysis when instantly performed by experienced operators. The “Herzinfarktverbund Essen” (HIVE) is an urban STEMI network supporting direct patient transfer for primary PCI to four PCI centers covering a city area of 600,000 inhabitants. Integrated health care is an optional part of the HIVE allowing for reimbursement of medical innovations such as the evaluation of infarct size and the presence and extent of microvascular obstruction by contrast-enhanced cardiac magnetic resonance (CMR). The aim of this study was to assess the prognostic impact of contrast-enhanced CMR in the patient cohort of a regional STEMI network.Patients and Methods:Within the 1st year (09/2004 to 08/2005) of the HIVE registry, 489 patients with acute myocardial infarction were treated in the four primary PCI centers. In one of the centers, including 143 patients, early CMR imaging using a standardized MR protocol for infarct quantification was performed whenever possible. Patients with hemodynamic instability, emergency coronary artery bypass grafting, resuscitation or death prior to CMR, claustrophobia, and other general contraindications to MRI had to be excluded, leaving 67 patients (54 male; mean age 61 ± 12 years) for final evaluation. CMR was performed 4.5 ± 2.5 days after admission on a 1.5-T MR scanner (Sonata, Siemens Medical Solutions, Erlangen, Germany) including steady-state free precession (SSFP) cine imaging for left ventricular function and single-shot inversion-recovery SSFP imaging for delayed enhancement (DE) and no-reflow (NR) evaluation following injection of 0.2 mmol/kg body weight gadodiamide (Omniscan®, GE Healthcare Buchler, Munich, Germany). NR and DE volumes were calculated from single-shot short-axis stacks taken within the 1st minute following gadodiamide infusion by manual planimetry and summation of disks. 1-year follow-up data (telephone interview) for major adverse cardiac events (MACE: cardiac death, myocardial infarction, and rehospitalization for congestive heart failure, angina pectoris, or revascularization) were available for all patients.Results:DE as a measure of infarct size was 9% ± 7% (range 0–33%) of left ventricular mass (LVM), and mean volume of microvascular obstruction was 2% ± 3% (range 0–17%). Microvascular obstruction was present in 61% of patients. 16 MACE (one cardiac death, one myocardial infarction, and 14 rehospitalizations for congestive heart failure or unstable angina pectoris with PCI in six cases) occurred within the follow-up period of 430 ± 63 days. Patients with MACE had larger infarcts (14% ± 10% vs. 8% ± 6% DE), lower left ventricular ejection fraction (LVEF 44% ± 17% vs. 48% ± 14%) and larger NR (3% ± 5% vs. 2% ± 3%). Using a stepwise logistic regression model, only NR > 0.5% of LVM was independently related to outcome (odds ratio = 3.9, confidence interval 1.1–13.9).Conclusion:NR as a correlate of microvascular obstruction remains independently related to prognosis in patients with acute myocardial infarction treated by PCI.ZusammenfassungHintergrund und Ziel:Infarktgröße und Prognose eines akuten ST-Strecken-Hebungsinfarkt (STEMI) profitieren von einer schnellen Wiedereröffnung des Infarktgefäßes und einer effektiven Wiederherstellung der myokardialen Perfusion. Dabei ist die primäre perkutane Koronarintervention (PCI) der systemischen thrombolytischen Therapie (Lysetherapie) überlegen. Der Herzinfarktverbund Essen (HIVE), ein regionales STEMI-Netzwerk, sichert den ca. 600 000 Einwohnern des Stadtgebiets Essen durch vier Interventionszentren eine leitlinienkonforme, zeitlich optimierte Versorgung von STEMI-Patienten durch primäre PCI. Integrierte Versorgung als Option im HIVE ermöglicht die extrabudgetäre Finanzierung medizinischer Innovationen wie der Beurteilung von Infarktgröße und mikrovaskulärer Obstruktion durch kontrastverstärkte kardiale MRT (CMR). Untersucht werden sollte die prognostische Bedeutung der kontrastverstärkten CMR im Patientenkollektiv eines regionalen STEMI-Netzwerks.Patienten und Methodik:489 Patienten wurden im 1. Jahr (09/2004–08/2005) des HIVE durch die vier Interventionszentren versorgt. Für die 143 Patienten eines Zentrums stand eine standardisierte CMR-Diagnostik zur Infarktquantifizierung zur Verfügung. Nach Ausschluss hämodynamischer Instabilität, notfallmäßiger operativer Myokardrevaskularisation, Reanimation oder Tod vor CMR sowie Klaustrophobie und sonstiger MR-typischer Kontraindikationen verblieben 67 Patienten (54 Männer, mittleres Alter 61 ± 12 Jahre) zur Auswertung. Die CMR erfolgte 4,5 ± 2,5 Tage nach stationärer Aufnahme an einem 1,5-T-MR-Scanner (Sonata, Siemens Medical Solution, Erlangen) mit einem Protokoll aus „steady-state free precession“-(SSFP-)Sequenzen zur Analyse der Ventrikelfunktion und „single-shot inversion-recovery“-SSFP-Sequenzen nach Kontrastmittelgabe zur Quantifizierung von Delayed Enhancement (DE) und No-Reflow (NR) mittels manueller Planimetrie und Scheibchensummation. Für alle Patienten lagen 1-Jahres-Ergebnisse für kardiale Ereignisse (MACE: kardialer Tod, Reinfarkt, Rehospitalisation wegen Herzinsuffizienz, Angina pectoris oder Revaskularisation) vor.Ergebnisse:Bei einer Infarktgröße (DE) von 9% ± 7% (0–33%) der linksventrikulären Masse (LVM) zeigten 61% der Patienten eine mikrovaskuläre Obstruktion (NR) mit 2% ± 3% (0–17%) der LVM. In der Verlaufsbeobachtung von 430 ± 63 Tagen traten 16 kardiale Ereignisse auf (ein kardialer Tod, ein Reinfarkt und 14 Rehospitalisationen wegen Herzinsuffizienz oder instabiler Angina pectoris mit PCI in sechs Fällen). Patienten mit Ereignis zeigten größere Infarkte (14% ± 10% vs. 8% ± 6% DE), eine schlechtere linksventrikuläre Funktion (LVEF 44% ± 17% vs. 48% ± 14%) und mehr mikrovaskuläre Obstruktion (NR 3% ± 5% vs. 2% ± 3%). Nach stufenweiser logistischer Regression verblieb NR > 0,5% LVM als prognostisch unabhängiger Parameter (Odds-Ratio = 3,9, Konfidenzintervall 1,1–13,9).Schlussfolgerung:NR als Korrelat einer mikrovaskulären Obstruktion ist bei PCI-behandelten STEMIPatienten im regionalen STEMI-Netzwerk HIVE ein unabhängiger Marker für eine schlechte Prognose.

Real life use of sirolimus-eluting coronary stents in Germany. Results from the prospective multi-centre German Cypher Registry.

„Drug-eluting“-Stents (DES) sind ein viel versprechender Ansatz zur Lösung der Rezidivstenoseproblematik bei der perkutanen transluminalen Koronarintervention (PCI). Die vorliegenden randomisierten Studien (RCT) schlossen jedoch nur Patienten mit relativ unproblematischen Läsionen ein. Wir untersuchten die Daten des deutschen Cypher-Register™-Registers, das parallel zur Zulassung des ersten DES, des Sirolimus beschichteten Cypher™-Koronarstents, im April 2002 begonnen wurde, bezüglich des Einsatzes dieses DES im klinischen Alltag. Von April 2002 bis März 2003 wurden 1638 Implantationen von Cypher™-Stents an 88 Kliniken in das deutsche Cypher™-Register eingeschlossen. Die mittlere Einschlussrate pro Zentrum und Monate war niedrig (< 3 Einschlüsse/ Monat und teilnehmender Klinik). Bei der Mehrzahl der Patienten lag eine stabile Angina pectoris (45,8%) vor. 6,4% der Patienten wurden jedoch wegen eines Nicht-ST-Hebungsinfarktes, 10,3% der Patienten wegen eines ST-Hebungsinfarktes und 1,7% der Patienten im kardiogenen Schock behandelt. Bei Patienten ohne einen ST-Hebungsinfarkt wurde eine de novo-Stenose in 68,4% der Fälle, eine Rezidivstenose in 4,1% und eine In-Stent Rezidivstenose in 25,5% der Fälle behandelt. Chronische Verschlüsse wurden bei 6,1% der Patienten behandelt. Eine Vor-Dilatation wurde bei 68,3% der Patienten durchgeführt und pro Patient wurden 1,05 ± 0,35 Cypher™-Stents mit einer medianen Länge von 18 mm (Quartile: 13–21 mm) implantiert. Zu einem PCI-assoziierten Todesfall kam es in 0,1% der Fälle und ein Q-Zacken-Myokardinfarkt entwickelte sich in 1,1% der Fälle. Eine erneute Notfall-PCI vor der Entlassung aus dem Krankenhaus erfolgte in 1,3% und eine notfallmäßige koronare Bypassoperation bei 0,1% der Fälle. Der Einsatz des Sirolimus beschichteten Cypher™-Stents im klinischen Alltag erwies sich während des Kliniksaufenthaltes als sicher bezüglich der akuten Komplikationen. In etwa der Hälfte der Fälle wurde der Sirolimus-Stent in der klinischen Routine bei Läsionen eingesetzt, die bislang nicht in randomisierten Studien untersucht wurden. Drugeluting stents (DES) are currently judged to be a “break-through” technology for the prevention of restenosis after percutaneous coronary interventions (PCI). However, experience is limited to randomised controlled clinical trials (RCT) in selected lesions and the currently available DES are more expensive compared to conventional “bare” stents. Therefore, actual clinical practice may be very different to RCT. We analysed the data of the German Cypher™ Registry, a nationwide registry which was initiated in parallel to the launch of the first DES, the Cypher™ sirolimus-eluting coronary stent, in April 2002. From April 2002 until March 2003, 1638 procedures at 88 hospitals were included in the German Cypher™ Registry . The mean inclusion rate per centre and month remained low (<3 procedures/month and participating hospital) during the whole inclusion period. Most patients presented with stable angina pectoris (45.8%); however, 6.4% of patients were treated for a non-ST elevation myocardial infarction, 10.3% of patients for ST elevation myocardial infarction and 1.7% in cardiogenic shock. In patients without ST elevation myocardial infarction, a de novo stenosis was treated in 68.4% of cases, a restenosis in 4.1%, and an in-stent restenosis in 25.5% of cases. Chronic total occlusions were treated in 6.1% of patients. Predilatation was performed in 68.3% of patients and 1.05 ± 0.35 Cypher™ stents were implanted per patient with a median (quartiles) stent length of 18 (13–21) mm. PCI-related death occurred in 0.1% of patients and a Q-wave myocardial infarction in 1.1%. Urgent re-PCI before hospital discharge was performed in 1.3% and urgent bypass surgery in 0.1% of cases. The use of the sirolimus-eluting coronary stents in this “real life” registry was found to be safe concerning acute complications. In about one half of the registry patients, the DES was implanted in lesions that were excluded from RCTs.

The Sirolimus-eluting coronary stent in daily routine practice in Germany: trends in indications over the years. Results from the prospective multi-centre German Cypher Stent Registry.

BackgroundDrugeluting coronary stents (DES) are increasingly used during percutaneous coronary interventions (PCI). Due to limited budgets in Germany, no special reimbursement has been given for their use and therefore they were mainly used in selected patients.MethodsIn order to determine the change in indications in patients treated with a Sirolimus-eluting stent (SES) in daily clinical practice between 2002 and 2005, we analysed data from a prospective multi-centre DES registry, the German Cypher Stent Registry.ResultsFrom April 2002 until September 2005, 11 507 patients at 132 hospitals, who received at least one SES during their PCI, were included. Between 2002 and 2005, the median age of patients increased from 63 years to 66 years (p for trend <0.0001), whereas the prevalence of prior coronary bypass surgery (p<0.0001) and prior PCI (p<0.001) significantly decreased. Initial presentation of patients was stable over time, with a small increase of patients treated for non-ST elevation myocardial infarction (p=0.05). We found a significant increase in the treatment of complex stenoses (p<0.0001) as well as an increase in the proportion of chronic total occlusions (p<0.01). There was a steady increase in the proportion of patients treated for de novo lesions (p<0.0001), which was accompanied by a relative decrease in the proportion of patients treated for in-stent restenosis (p<0.0001). Concerning interventional characteristics a significant increase in the length of SES implanted per lesion, the numbers of SES implanted per lesion as well as an increase of the proportion of patients treated for more than one stenosis during one intervention could be observed (all p<0.0001). There was a significant decrease in the use of glycoprotein II b/IIIa antagonists during the PCI (2002: 26.5 to 14.2% in 2005, p<0.0001). MACE rates until hospital discharge did not change significantly over time.ConclusionsBetween 2002 and 2005 there were two trends in the use of SES: a) a significant increase in the use of SES for de novo lesions and b) a significant trend to use SES for longer lesions, smaller arteries, more complex lesions and more SES per lesion. In summary these findings indicate that still SES are mainly used in patients with lesions that are at high risk for restenosis.

Current variables, definitions and endpoints of the European Cardiovascular Magnetic Resonance Registry

BackgroundCardiovascular Magnetic Resonance (CMR) is increasingly used in daily clinical practice. However, little is known about its clinical utility such as image quality, safety and impact on patient management. In addition, there is limited information about the potential of CMR to acquire prognostic information.MethodsThe European Cardiovascular Magnetic Resonance Registry (EuroCMR Registry) will consist of two parts: 1) Multicenter registry with consecutive enrolment of patients scanned in all participating European CMR centres using web based online case record forms. 2) Prospective clinical follow up of patients with suspected coronary artery disease (CAD) and hypertrophic cardiomyopathy (HCM) every 12 months after enrolment to assess prognostic data.ConclusionThe EuroCMR Registry offers an opportunity to provide information about the clinical utility of routine CMR in a large number of cases and a diverse population. Furthermore it has the potential to gather information about the prognostic value of CMR in specific patient populations.

Impact of Admission Blood Glucose on Outcomes of Nondiabetic Patients With Acute ST-Elevation Myocardial Infarction (from the German Acute Coronary Syndromes [ACOS] Registry)

High blood glucose in patients with acute coronary syndromes have been associated with adverse short-term outcomes in patients without diabetes. However, the relation of admission glucose to long-term outcomes in these patients was less well established. Accordingly, consecutive patients with ST-elevation myocardial infarction (STEMI) without diabetes enrolled at 155 sites from July 2000 to November 2002 in the ACOS Registry were evaluated. Patients were categorized into tertiles based on admission blood glucose. Clinical end points of interest were 1-year mortality and composite of death, reinfarction, stroke, or rehospitalization (major adverse cardiac clinical events [MACCEs]) in the hospital and after discharge. Of 5,866 patients with STEMI, 36.9% had blood glucose <120 mg/dl; 33.1%, 120 to 150 mg/dl; and 30.0%, >150 mg/dl. Admission blood glucose was significantly related to increased risk of not only in-hospital events (death, glucose >150 vs <120 mg/dl, adjusted odds ratio [OR] 2.86, 95% confidence interval [CI] 2.13 to 3.82, p <0.0001; and MACCE, >150 vs <120 mg/dl, adjusted OR 1.88, 95% CI 1.52 to 2.33; p <0.0001), but this increased risk persisted beyond the acute phase during 1-year follow-up of a mean 380 days (median 387; death, glucose >150 vs <120 mg/dl, adjusted OR 1.46, 95% CI 1.04 to 2.03, p <0.0001; and MACCE, >150 vs <120 mg/dl, adjusted OR 1.31, 95% CI 1.00 to 1.71, p <0.0001). In conclusion, high blood glucose at admission to the hospital independently correlated with short- and midterm mortality in patients with STEMI.