title: 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.
authors.affiliation: Acute myocardial infarction and unstable angina in Switzerland (AMIS Plus) Data Center, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Damaris
authors.initials: D
authors.lastname: Müdespacher
authors.forename: Dragana
authors.initials: D
authors.lastname: Radovanovic
authors.forename: Edoardo
authors.initials: E
authors.lastname: Camenzind
authors.forename: Manfred
authors.initials: M
authors.lastname: Essig
authors.forename: Osmund
authors.initials: O
authors.lastname: Bertel
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
authors.forename: Franz Robert
authors.initials: FR
authors.lastname: Eberli
authors.forename: Felix
authors.initials: F
authors.lastname: Gutzwiller
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D012044:Regression Analysis; D012737:Sex Factors; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose