title: Admission proinsulin is associated with mortality in patients with admission hyperglycemia during acute coronary syndrome: results from a pilot observational study.
abstract: BACKGROUND
  Acute hyperglycemia (AHG) is associated with mortality in patients with acute coronary syndrome (ACS). The extent to which hyperproinsulinemia contributes to worse clinical outcomes for this specific patient population is unknown.
  
  
  METHODS
  We included 308 consecutive ACS patients who underwent coronary angioplasty in this pilot observational study. Patients were separated into 3 groups: patients with proven diabetes mellitus (DM group) (n =55), nondiabetic patients with a normal glucose concentration at admission (NAG group) (n =175), and nondiabetic patients with AHG at presentation (AHG group) (n =78). Blood samples for glucose, insulin, and proinsulin measurements were obtained at admission. The primary end point of the study was all-cause mortality, which was assessed at a mean follow-up of 19 months (interquartile range, 12-28 months).
  
  
  RESULTS
  Patients in the AHG and DM groups had significantly (P =0.048) higher all-cause mortality compared with the NAG group. A univariate Cox regression analysis revealed that the proinsulin concentration was significantly associated with all-cause mortality for all study participants (hazard ratio, 1.013; 95% CI, 1.002-1.024; P =0.023). AHG patients with increased proinsulin concentrations showed a mortality rate similar to that of DM patients but had a significantly higher mortality rate than patients with AHG and a low proinsulin concentration (χ² =7.57; P =0.006) and patients with NAG (with or without increased proinsulin) [χ² =7.66 (P =0.006) and 13.98 (P < 0.001), respectively]. A multivariate regression analysis revealed that the concentrations of glucose and proinsulin at admission were significant (P =0.002) predictors of all-cause mortality.
  
  
  CONCLUSIONS
  An increased proinsulin concentration may be a marker for mortality in ACS patients with hyperglycemia at admission and without known diabetes. Further studies are needed to evaluate the role of metabolic parameters such as proinsulin.
authors.affiliation: Third Department of Medicine, Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria. serdarfarhan@yahoo.de
authors.forename: Serdar
authors.initials: S
authors.lastname: Farhan
authors.forename: Rudolf
authors.initials: R
authors.lastname: Jarai
authors.forename: Ioannis
authors.initials: I
authors.lastname: Tentzeris
authors.forename: Matthias K
authors.initials: MK
authors.lastname: Freynhofer
authors.forename: Ivan
authors.initials: I
authors.lastname: Brozovic
authors.forename: Birgit
authors.initials: B
authors.lastname: Vogel
authors.forename: A
authors.initials: A
authors.lastname: Kautzky-Willer
authors.forename: Thomas
authors.initials: T
authors.lastname: Wascher
authors.forename: Johann
authors.initials: J
authors.lastname: Wojta
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000628:therapy; D000368:Aged; D017130:Angioplasty; D003920:Diabetes Mellitus / Q000097:blood / Q000401:mortality; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000150:complications / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011384:Proinsulin / Q000097:blood*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D015607:Stents
chemical_list: D011384:Proinsulin