title: Fasting glucose in acute myocardial infarction: incremental value for long-term mortality and relationship with left ventricular systolic function.
abstract: OBJECTIVE
  Elevation of blood glucose is a common metabolic disorder among patients with acute myocardial infarction (AMI) and is associated with adverse prognosis. However, few data are available concerning the long-term prognostic value of elevated fasting glucose during the acute phase of infarction.
  
  
  METHODS
  We prospectively studied the relationship between fasting glucose and long-term mortality in patients with AMI. Fasting glucose was determined after an >/=8 h fast within 24 h of admission. The median duration of follow-up was 24 months (range 6-48). All multivariable Cox models were adjusted for the Global Registry of Acute Coronary Events (GRACE) risk score.
  
  
  RESULTS
  In nondiabetic patients (n = 1,101), compared with patients with normal fasting glucose (<100 mg/dl), the adjusted hazard ratio for mortality progressively increased with higher tertiles of elevated fasting glucose (first tertile 1.5 [95% CI 0.8-2.9], P = 0.19; second tertile 3.2 [1.9-5.5], P < 0.0001; third tertile 5.7 [3.5-9.3], P < 0.0001). The c statistic of the model containing the GRACE risk score increased when fasting glucose data were added (0.8 +/- 0.02-0.85 +/- 0.02, P = 0.004). Fasting glucose remained an independent predictor of mortality after further adjustment for ejection fraction. Elevated fasting glucose did not predict mortality in patients with diabetes (n = 462).
  
  
  CONCLUSIONS
  Fasting glucose is a simple robust tool for predicting long-term mortality in nondiabetic patients with AMI. Fasting glucose provides incremental prognostic information when added to the GRACE risk score and left ventricular ejection fraction. Fasting glucose is not a useful prognostic marker in patients with diabetes.
authors: Department of Cardiology, Rambam Medical Center, Haifa, Israel. daronson@tx.technion.ac.il
authors: Doron
authors: D
authors: Aronson
authors: Haim
authors: H
authors: Hammerman
authors: Michael R
authors: MR
authors: Kapeliovich
authors: Abeer
authors: A
authors: Suleiman
authors: Yoram
authors: Y
authors: Agmon
authors: Rafael
authors: R
authors: Beyar
authors: Walter
authors: W
authors: Markiewicz
authors: Mahmoud
authors: M
authors: Suleiman
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D003925:Diabetic Angiopathies / Q000097:blood* / Q000401:mortality; D005215:Fasting; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D016019:Survival Analysis; D013599:Systole; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000097:blood*; D016277:Ventricular Function, Left
chemical_list: D001786:Blood Glucose