Impact of Acute Hyperglycemia on Clinical Outcomes in ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

Abstract

Objectives: To evaluate the impact of acute hyperglycemia on clinical outcomes among patients undergoing Primary Percutaneous Coronary Intervention (PPCI) for ST-Elevation Myocardial Infarction (STEMI). Methodology: This retrospective cohort study was conducted at Maqsood Medical Complex, Peshawar, between June 2024 and June 2025. A total of 300 STEMI patients (mean age 59 years; 52% male) were included and stratified into two groups: those presenting with hyperglycemia (blood glucose >140 mg/dL) and those without. Data on mortality, heart failure, and procedural complications were obtained from hospital records and analyzed using chi-square and independent t-tests. Multivariate logistic regression was performed to assess independent predictors of adverse outcomes. Results: Patients with acute hyperglycemia exhibited significantly higher rates of in-hospital mortality (15% vs. 5%, p < 0.05), heart failure (18% vs. 10%, p < 0.01), and complications such as the no-reflow phenomenon and contrast-induced nephropathy (CIN) compared with normoglycemic patients (p < 0.05). The incidence of Major Adverse Cardiac Events (MACE) was also higher among the hyperglycemia group (22% vs. 15%, p < 0.05). Logistic regression indicated that while acute hyperglycemia correlated strongly with poor outcomes, it did not emerge as an independent predictor of mortality after adjusting for confounders. Conclusion: Acute hyperglycemia significantly worsens early clinical outcomes in STEMI patients undergoing PPCI, leading to increased rates of mortality and complications. These findings emphasize the importance of early recognition and control of hyperglycemia to improve prognosis and reduce adverse cardiac events.