title: [Influence of admission glucose level on long-term prognosis in patients with acute coronary syndrome].
abstract: OBJECTIVE
  Hyperglycemia can increase the risk of death or a poor outcome following myocardial infarction. Our objective was to investigate the value of the admission glucose level in predicting long-term outcome in patients with acute coronary syndrome.
  
  
  METHODS
  The study population comprised 565 patients admitted with acute coronary syndrome within 24 hours of the start of symptoms. The final diagnosis was myocardial infarction in 56% and unstable angina in 44%.
  
  
  RESULTS
  The patients' mean glucose level was 143 (77) mg/dL. During follow-up (42 [6] months), 55 (9.7%) patients died. The area under the receiver operating characteristic curve for the optimum cut point for predicting death from the glucose level was 0.67; the cut point was 128 mg/dL, with a sensitivity of 85% and a specificity of 62%. Patients were divided into 2 groups according to blood glucose level: in group 1 (36.8%), it was > or = 128 mg/dL; in group 2, <128 mg/dL. There were differences between the groups in the incidence of diabetes (47.2% vs 12.6%; P< .001), systolic blood pressure (138 [33] mm Hg vs 133 [33] mm Hg; P< .001), and ejection fraction (48.3 [0.9]% vs 55.2 [12.4]%; P=.004). At 4 years, the survival rates were 40% and 77% in groups 1 and 2, respectively (log rank test P< .001). The following were independent predictors of mortality: admission glucose level > or =128 mg/dL (hazard ratio [HR= 2.41; P=.021), admission systolic blood pressure (HR= 0.97; P< .001), admission troponin-T level (HR=4.88; P< .001), and the development of heart failure (HR=1.04; P=.001). A rise of 10 mg/dL in glucose level was associated with a 2.56-fold increase in the risk of death (P=.012).
  
  
  CONCLUSIONS
  In patients with acute coronary syndrome, hyperglycemia at admission (cut point > or =128 mg/dL) was associated with increased long-term risk and, in addition, was a strong independent predictor of mortality.
authors.affiliation: Unidad de Cuidados Intensivos Coronarios, Instituto de Cardiología Juana F. Cabral, Corrientes, Argentina. macinucic@hotmail.com
authors.forename: Stella M
authors.initials: SM
authors.lastname: Macín
authors.forename: Eduardo R
authors.initials: ER
authors.lastname: Perna
authors.forename: María L
authors.initials: ML
authors.lastname: Coronel
authors.forename: Jorge O
authors.initials: JO
authors.lastname: Kriskovich
authors.forename: Pablo A
authors.initials: PA
authors.lastname: Bayol
authors.forename: Valeria A
authors.initials: VA
authors.lastname: Franciosi
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Riera-Stival
authors.forename: Bilda
authors.initials: B
authors.lastname: González-Arjol
authors.forename: Jorge R
authors.initials: JR
authors.lastname: Badaracco
mesh_terms: D000789:Angina, Unstable / Q000097:blood* / Q000401:mortality; D019540:Area Under Curve; D001786:Blood Glucose / Q000032:analysis*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D013577:Syndrome
chemical_list: D001786:Blood Glucose