Hyperglycaemia at admission in acute coronary syndrome patients: prognostic value in diabetics and non-diabetics.
OBJECTIVE
To evaluate the impact of admission glycaemia on short-term and long-term prognosis in diabetic and non-diabetic patients admitted for acute coronary syndromes (ACS), and to identify the independent predictors of post-ACS mortality in this population.


METHODS
This study included 1149 consecutive patients admitted to a single coronary care unit for ACS between May 2004 and December 2006. Our population was divided into four groups according to the quartiles of glycaemia at admission [Q1 <5.77 mmol/l, Q2 (5.77-7.0) mmol/l, Q3 (7.0-9.22) mmol/l and Q4 > or =9.22 mmol/l]. Diabetic (n = 396) and non-diabetic (n = 753) subgroups were then separately analysed.


RESULTS
Hyperglycaemia at admission was associated with worse cardiovascular risk profile, high levels of necrosis and inflammation biomarkers and low left ventricle ejection fraction. Considering overall population, in-hospital, 30-day and 3-year mortalities were higher in more elevated glycaemia quartiles. In diabetic patients, there were no significant differences in mortality among glycaemia quartiles; however, in non-diabetic group higher admission glucose levels were associated with successively higher in-hospital and 3-year mortalities. After multivariate regression analysis, glycaemia at admission > or =5.77 mmol/l, age > or =72 years, Killip class >1 and troponin I > or =6.0 ng/ml were independent predictors of in-hospital mortality.


CONCLUSIONS
This study suggests that, in a broad ACS population, hyperglycaemia at admission is a short-term and long-term bad prognosis marker, particularly in non-diabetic patients, being a strong independent predictor of in-hospital mortality.
Monteiro
Sílvia
S
Cardiology Department, Coimbra University Hospital, Coimbra, Portugal. silvia.reis.monteiro@gmail.com
Monteiro
Pedro
P
Gonçalves
Francisco
F
Freitas
Mário
M
Providência
Luís A
LA
D054058:Acute Coronary Syndrome / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000628:therapy; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D016009:Chi-Square Distribution; D048909:Diabetes Complications / Q000097:blood / Q000401:mortality* / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
D015415:Biomarkers; D001786:Blood Glucose; D019210:Troponin I