New-onset hyperglycemia and acute coronary syndrome: a systematic overview and meta-analysis.
BACKGROUND
Patients without a history of diabetes often develop hyperglycemia during an acute coronary syndrome (ACS). New onset of hyperglycemia (NH) is associated with higher mortality both in the short and long-term.


OBJECTIVE
We performed a systematic review and meta-analysis of observational studies to investigate the association between NH and mortality in patients with ACS. In-hospital, 30-day and long-term mortality were analyzed separately.


METHODS
We searched MEDLINE for prospective studies of patients with ACS reporting the association between NH and mortality, using Research Methodology Filters. This was supplemented by hand searching reference lists of retrieved articles. We determined study eligibility and conducted data abstraction independently and disagreements were resolved by consensus. We pooled odds ratios (OR) from individual studies using a random effects model.


RESULTS
Our search strategy identified 24 studies. The prevalence of NH varied widely 3% to 71% depending on the definition of NH used. NH significantly increased the risk of in-hospital (OR 3.62, 95% CI: 3.09 - 4.24; p < 0.0001, I2=0.0%; 15 studies, 10673 patients), 30-day (OR 4.81, 95% CI: 2.18 - 10.61, p < 0.0001, I2=92.2%; 4 studies, 101447 patients), and long-term (up to 108 months) mortality (OR 2.02, 95% CI: 1.62-2.51; p < 0.0001, I2=79.4%; 12 studies, 102099 patients).


CONCLUSIONS
In patients without a prior diagnosis of diabetes who are admitted to hospital for ACS, NH increases the risk of both short and long-term mortality. These data highlight the need for further studies addressing the control of blood glucose levels in patients with ACS.


CONCLUSIONS
Patients without history of diabetes may develop new hyperglycemia (NH) on admission to hospital for AMI. We systematically reviewed the prognostic impact of NH on short- and long-term mortality in patients without prior diagnosis of diabetes who attended the hospital for ACS. We identified 24 outcome studies which met a set of pre-specified criteria. Prevalence of NH ranged from 3% to 71% according to different thresholds of blood glucose concentrations. NH significantly increased the risk of in-hospital (OR 3.62, 95% CI: 3.09 - 4.24; p < 0.0001, I2=0.0%; 15 studies, 10673 patients), 30-day (OR 4.81, 95% CI: 2.18 - 10.61, p < 0.0001, I2=92.2%; 4 studies, 101447 patients)), and long-term (up to 108 months) mortality (OR 2.02, 95% CI: 1.62-2.51; p < 0.0001, I2=79.4%; 12 studies, 102,099 patients).
Angeli
Fabio
F
Department of Cardiology, Hospital Santa Maria della Misericordia, 06100 Perugia - Italy. fangeli@cardionet.it
Verdecchia
Paolo
P
Karthikeyan
Ganesan
G
Mazzotta
Giovanni
G
Del Pinto
Maurizio
M
Repaci
Salvatore
S
Gatteschi
Camillo
C
Gentile
Giorgio
G
Cavallini
Claudio
C
Reboldi
Gianpaolo
G
D054058:Acute Coronary Syndrome / Q000097:blood / Q000401:mortality*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D048909:Diabetes Complications / Q000175:diagnosis / Q000453:epidemiology*; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000453:epidemiology*; D010343:Patient Admission; D011379:Prognosis
D001786:Blood Glucose