Admission glycaemia and outcome in patients with acute coronary syndrome

Abstract

Some studies of patients with acute myocardial infarction have reported that hyperglycaemia at admission may be associated with a worse outcome. This study sought to evaluate the association of blood glucose at admission with the outcome of unselected patients with acute coronary syndrome (ACS). Using the Acute Myocardial Infarction and unstable angina in Switzerland (AMIS Plus) registry, ACS patients were stratified according to their blood glucose on admission: group 1: 2.80-6.99 mmol/L, group 2: 7.00-11.09 mmol/L and group 3: > 11.10 mmol/L. Odds ratios for in-hospital mortality were calculated using logistic regression models. Of 2,786 patients, 73% were male and 21% were known to have diabetes. In-hospital mortality increased from 3% in group 1 to 7% in group 2 and to 15% in group 3. Higher glucose levels were associated with larger enzymatic infarct sizes (p<0.001) and had a weak negative correlation with angiographic or echographic left ventricular ejection fraction. High admission glycaemia in ACS patients remains a significant independent predictor of in-hospital mortality (adjusted OR 1.08; 95% confidence intervals [CI] 1.05-1.14, p<0.001) per mmol/L. The OR for in-hospital mortality was 1.04 (95% CI 0.99-1.1; p=0.140) per mmol/L for patients with diabetes but 1.21 (95% CI 112-1.30; p<0.001) per mmol/L for non-diabetic patients. In conclusion, elevated glucose level in ACS patients on admission is a significant independent predictor of in-hospital mortality and is even more important for patients who do not have known diabetes. Using the Acute Myocardial Infarction and unstable angina in Switzerland (AMIS Plus) registry, ACS patients were stratified according to their blood glucose on admission: group 1: 2.80-6.99 mmol/L, group 2: 7.00-11.09 mmol/L and group 3: > 11.10 mmol/L. Odds ratios for in-hospital mortality were calculated using logistic regression models.Of 2,786 patients, 73% were male and 21% were known to have diabetes. In-hospital mortality increased from 3% in group 1 to 7% in group 2 and to 15% in group 3. Higher glucose levels were associated with larger enzymatic infarct sizes (p<0.001) and had a weak negative correlation with angiographic or echographic left ventricular ejection fraction. High admission glycaemia in ACS patients remains a significant independent predictor of in-hospital mortality (adjusted OR 1.08; 95% confidence intervals [CI] 1.05-1.14, p<0.001) per mmol/L. The OR for in-hospital mortality was 1.04 (95% CI 0.99-1.1; p=0.140) per mmol/L for patients with diabetes but 1.21 (95% CI 112-1.30; p<0.001) per mmol/L for non-diabetic patients.In conclusion, elevated glucose level in ACS patients on admission is a significant independent predictor of inhospital mortality and is even more important for patients who do not have known diabetes.

Comparison of conventional risk factors in middle-aged versus elderly diabetic and nondiabetic patients with myocardial infarction: prediction with decision–analytic model

“…patients with acute coronary syndrome (ACS) on admission are a significant independent predictor of hospital mortality and this is even more important for patients who do not have known diabetes [Müdespacher et al 2007]. Unrecognized diabetes and abnormal glycemic state were common in patients admitted with ACS.…”

Glucose dysmetabolism and prognosis in critical illness

“…Furthermore, fasting glucose remains an independent predictor of long-term mortality after adjustment for left ventricular ejection fraction. Recently also in patients with acute coronary syndrome [35], an elevated glucose level on admission is a significant independent predictor of in-hospital mortality, and is even more important in patients who do not have known diabetes.…”

Combination of ankle brachial index and diabetes mellitus to predict cardiovascular events and mortality after an acute coronary syndrome

“…Indeed, the risk of a diabetic patients without previous myocardial infarction is as high as the risk of a non-diabetic patient with a myocardial infarction [1][2][3]. In addition, the presence of hyperglycemia or diabetes mellitus in the setting of an acute coronary syndrome (ACS) is associated with markedly increased mortality rates [4][5][6][7][8]. Peripheral arterial disease (PAD) is a manifestation of atherosclerosis characterized by occlusive disease of the lower extremities and is a marker for atherothrombotic disease in other vascular beds, including the coronary arteries [9].…”