title: Prognostic importance of admission versus persistent glycemia in acute coronary syndrome.
abstract: BACKGROUND
  Whether persistent hyperglycemia (PG) during hospitalisation has a greater impact on adverse outcomes in acute myocardial infarction (AMI) than a single random glucose measurement is not well defined.
  
  
  OBJECTIVE
  To find out the association of admission glycemia (AG) VS PG on outcomes in patients of ACS.
  
  
  METHODS
  Prospective, cohort, hospital-based. We evaluated 200 patients of ACS for admission and in-hospital glycemia and their impacts on outcomes. AG was defined as a plasma glucose >198 mg/dl and PG as a random glucose >140 mg/dl at any point during hospitalisation. Demographic and biochemistry including risk factors recorded. A multiple regression was done to evaluate association of various parameters with worse prognosis.
  
  
  RESULTS
  Of the 200 patients evaluated, 35 (17.5%) presented with AG. 31 (15.5%) had PG. Males were predominant and 47 (23%) previously known diabetic patients. 62 (31%) had unstable angina, 52 (26%) NSTEMI and 86 (43%) STEMI, between PG and LEF, higher troponin levels and in-hospital mortality and between LEF and age (p<0.001), serum creatinine (p 0.023) and mean in-hospital glucose (p 0.005). F-indices were compared with AG for their ability to discriminate hospitalization survivors from non-survivors. All average glucose metrics performed better than AG. The ability of these models improved as the time window increased (F-indices for admission, mean 24h, 48 h and 72 h were 2.51, 12.05, 8.3 and 5.72, respectively).
  
  
  CONCLUSIONS
  The present study demonstrates that PG is a better discriminator of prognosis than AG in patients of ACS.
authors.affiliation: Department of Medicine, J N Medical College, AMU, Aligarh, UP, India.
authors.forename: M
authors.initials: M
authors.lastname: Shoaib Zaheer
authors.forename: Muhammad
authors.initials: M
authors.lastname: Uwais Ashraf
authors.forename: M U
authors.initials: MU
authors.lastname: Rabbani
authors.forename: Jamal
authors.initials: J
authors.lastname: Ahmad
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000401:mortality; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000401:mortality; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human