Glycemia at admission: the metabolic echocardiography in acute coronary syndrome patients.
BACKGROUND
Ventricular dysfunction in acute coronary syndrome (ACS) patients is a recognized predictor of in-hospital and post-discharge morbidity and mortality. Recently, hyperglycemia at admission has been considered as an important marker of poor in-hospital prognosis.


OBJECTIVE
To characterize an ACS population and to identify independent predictors of one-year mortality.


METHODS
This study included 1179 consecutive patients admitted to a single coronary care unit for acute coronary syndrome between May 2004 and December 2006. Patients were followed up for 12 months after ACS.


RESULTS
In our population, 70.9% of patients were male, with a mean age of 66.6+/-12.5 years; 15.7% were admitted by unstable angina, 44.7% by non-ST elevation myocardial infarction and 38.5% by ST elevation myocardial infarction; 16% of patients had left ventricular systolic dysfunction during the index admission. In-hospital mortality was 3.5% and complications occurred in 5.6% of patients. Mortality rate at 1-year of follow-up was 8.8% and rehospitalization rate for heart failure was 5.5%. After multivariate regression analysis, left ventricular systolic dysfunction [odds ratio (OR): 3.58; confidence interval (CI): 1.57-8.16], glycemia at admission >137 mg/dl (OR: 3.58; CI: 1.52-8.47) and age >65 years (OR: 2.67; CI: 1.08-6.59) were independent predictors of 1-year mortality.


CONCLUSIONS
In this population, hyperglycemia at admission was an independent predictor of 1-year mortality, with a predictive value equivalent to that of left ventricular systolic dysfunction. This fact, never before described, emphasizes the importance of metabolic abnormalities and their control in the prognosis of ACS patients.
Monteiro
Sílvia
S
Department of Cardiology, Coimbra University Hospital, Coimbra, Portugal. silvia.reis.monteiro@gmail.com
António
Natália
N
Gonçalves
Francisco
F
Monteiro
Pedro
P
Freitas
Mário
M
Providência
Luís A
LA
D054058:Acute Coronary Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy; D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality* / Q000628:therapy