Hyperglycaemia at admission in acute coronary syndrome patients: prognostic value in diabetics and non-diabetics

Monteiro, Sílvia; Monteiro, Pedro; Gonçalves, Francisco; Freitas, Mário; Providência, Luí­s A.

doi:10.1097/hjr.0b013e32832e19a3

Cited by 34 publications

(24 citation statements)

References 30 publications

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“…Several studies have demonstrated that acute hyperglycemia is a powerful predictor of mortality, larger infarct size and increased risk of cardiovascular complications in myocardial infarction patients regardless of the diabetic state [30][31][32][33][34][35]. For every 18-mg/ dL increase in glucose level, there is a 4% increase in mortality in nondiabetic patients presenting with myocardial infarction [36].…”

Section: Discussionmentioning

confidence: 99%

Acute Hyperglycemia an Independent Risk Factor for Contrast-Induced Nephropathy in Patients Undergoing Primary Percutaneous Coronary Intervention for STEMI

Khorshid

Gomaa

Tamara

et al. 2017

JCCR

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Section: Discussionmentioning

confidence: 99%

Acute Hyperglycemia an Independent Risk Factor for Contrast-Induced Nephropathy in Patients Undergoing Primary Percutaneous Coronary Intervention for STEMI

Khorshid

Gomaa

Tamara

et al. 2017

JCCR

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“…[1][2][3][4][5][6][7][8][9] In fact, in a broad ACS population, hyperglycaemia at admission is a short-term and long-term prognostic marker. 1 A high glucose level at admission is often attributed to 'stress hyperglycaemia' and might reflect an acute response to the hyperadrenergic state, with catecholamine release and induction of glycogenolysis.…”

Section: Discussionmentioning

confidence: 99%

“…1 It is useful in patients both with and without diabetes. [2][3][4][5][6][7][8][9] It is usually caused by stress hyperglycaemia induced by catecholamines, which, in turn, are correlated with myocardial lesion extension. 1 However, risk scores applied in clinical practice do not include this variable.…”

Section: Introductionmentioning

confidence: 99%

Prognostic impact of admission blood glucose for all-cause mortality in patients with acute coronary syndromes: added value on top of GRACE risk score

Timóteo

Papoila

Rio

et al. 2014

European Heart Journal: Acute Cardiovascular Care

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Background: Abnormal glucose metabolism is a predictor of worse outcome after acute coronary syndrome (ACS). However, this parameter is not included in risk prediction scores, including GRACE risk score. We sought to evaluate whether the inclusion of blood glucose at admission in a model with GRACE risk score improves risk stratification. Methods: Study of consecutive patients included in a single centre registry of ACS. Our primary endpoint was the occurrence of all-cause mortality at one-year follow-up. The ability of the two logistic regression models (GRACE risk score alone and in combination with blood glucose) to predict death was analysed. Continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI), with corresponding 95% confidence intervals (CIs), were also calculated. Results: We included 2099 patients, with a mean age of 64 (SD=13) years, 69% males. In our sample, 55.1% presented with ST-segment elevation ACS and 13.1% in Killip class ≥ 2. Only 25% were known diabetic at admission. In-hospital mortality was 5.8% and 9.7% at one-year follow-up. The best cut-point for blood glucose was 160 mg/dl (sensitivity 62% and specificity 68%), and 35.2% of the patients had increased levels. This group was elderly, had more prevalence of cardiovascular risk factors, worse renal function and GRACE score as well as more frequently Killip class ≥2. Treatment was similar in both groups besides less frequent use of clopidogrel in high glycaemic patients. The hyperglycaemia group had higher one-year mortality (17.2% vs. 5.6%, p<0.001). Moreover, binary blood glucose remained a predictor of death independently of the GRACE risk score and the presence of diabetes (odds ratio (OR) 1.99, 95% CI 1.40–2.84, p<0.001). The inclusion of blood glucose, as a continuous variable, in a logistic regression model with GRACE score, increased the area under the ROC curve from 0.80 to 0.82 (p=0.018) as well as the goodness-of-fit and was associated with an improvement in both the NRI (37%) and the IDI (0.021), suggesting effective reclassification. Conclusions: A blood glucose level on admission ≥ 160 mg/dl is an independent predictor of mortality in medium-term follow-up. It offers an incremental predictive value when added to the GRACE risk score, although with a modest magnitude of improvement, probably due to the high predictive performance of the GRACE risk score alone.

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“…Moderate control of glycaemia is advised currently. In the latest ESC guidelines, it is emphasized that insulin should be considered in patients presenting with ACS and with hyperglycemia (> 10 mmol/L or > 180 mg/dL), taking into account the comorbidities [1,21,[24][25][26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Diabetic Patients with an Acute Myocardial Infarction in Terms of Risk Factors and Comorbidities Management: Characteristics of the Highest-Risk Individuals

et al. 2016

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Hyperglycaemia at admission in acute coronary syndrome patients: prognostic value in diabetics and non-diabetics

Abstract: This study suggests that, in a broad ACS population, hyperglycaemia at admission is a short-term and long-term bad prognosis marker, particularly in non-diabetic patients, being a strong independent predictor of in-hospital mortality.

Cited by 34 publications

References 30 publications

Acute Hyperglycemia an Independent Risk Factor for Contrast-Induced Nephropathy in Patients Undergoing Primary Percutaneous Coronary Intervention for STEMI

Acute Hyperglycemia an Independent Risk Factor for Contrast-Induced Nephropathy in Patients Undergoing Primary Percutaneous Coronary Intervention for STEMI

Prognostic impact of admission blood glucose for all-cause mortality in patients with acute coronary syndromes: added value on top of GRACE risk score

Diabetic Patients with an Acute Myocardial Infarction in Terms of Risk Factors and Comorbidities Management: Characteristics of the Highest-Risk Individuals

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