title: Association between blood glucose and long-term mortality in patients with acute coronary syndromes in the OPUS-TIMI 16 trial.
abstract: Hyperglycemia in the context of acute coronary syndrome (ACS) is a common observation, and existing data suggest that high glucose levels are associated with increased in-hospital mortality. We assessed the relation between random glucose and long-term mortality in 9,020 patients with ACS who were enrolled in the OPUS-TIMI 16 trial. A significant relation between glucose level and 10-month mortality was observed (2.7% in quartile 1 vs 7.0% in quartile 4, p <0.0001). After multivariable adjustment for co-morbidity, which included history of diabetes, this relation remained significant (quartile 4 vs 1, hazard ratio 1.70, 95% confidence interval 1.16 to 2.50, p = 0.006). These observations were similar in the TACTICS-TIMI 18 trial. In addition, we observed that B-type natriuretic peptide and troponin I levels increased across glucose quartiles in the OPUS-TIMI 16 trial (p values for trend = 0.002 and 0.0001, respectively) and the TACTICS-TIMI 18 trial (p values for trend = 0.006 and 0.0001, respectively). High blood glucose during ACS is an independent predictor of long-term mortality and is significantly correlated with prognostic biomarkers. Glucose levels during ACS may be an important addition to the risk stratification of patients with ACS and a potentially important target for therapy.
authors.affiliation: McLaren Regional Medical Center/Michigan State University, Flint, Michigan, USA.
authors.forename: Satish
authors.initials: S
authors.lastname: Bhadriraju
authors.forename: Kausik K
authors.initials: KK
authors.lastname: Ray
authors.forename: Anthony C
authors.initials: AC
authors.lastname: DeFranco
authors.forename: Kim
authors.initials: K
authors.lastname: Barber
authors.forename: Padmini
authors.initials: P
authors.lastname: Bhadriraju
authors.forename: Sabina A
authors.initials: SA
authors.lastname: Murphy
authors.forename: David A
authors.initials: DA
authors.lastname: Morrow
authors.forename: Carolyn H
authors.initials: CH
authors.lastname: McCabe
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
mesh_terms: D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D005343:Fibrinolytic Agents