title: Hyperglycemia in patients referred for cardiac catheterization is associated with preexisting diabetes rather than a stress-related phenomenon: a prospective cross-sectional study.
abstract: BACKGROUND
  An increased serum glucose level in patients with acute coronary syndrome (ACS) is associated with adverse clinical outcome. This hyperglycemia has been attributed, at least in part, to acute stress reaction. Our objective was to determine whether hyperglycemia is a stress-related phenomenon or whether it represents a more sustained and possibly significant background dysglycemia.
  
  
  OBJECTIVE
  Hyperglycemia in patients undergoing coronary angiography is related to background dysglycemia.
  
  
  METHODS
  Blood samples were obtained at the time of cardiac catheterization. Patients with hemoglobin A1c >6.5% were excluded to avoid patients with chronic glucose levels above 135 mg/dL. A logistic regression model was created to assess the influence of different variables on hyperglycemia (glucose levels above 140 mg/dL). We also evaluated the effect of glucose levels above 140 mg/dL on major adverse cardiovascular events (MACEs) up to 36 months.
  
  
  RESULTS
  There were 2554 consecutive patients prospectively recruited. Serum glucose levels above 140 mg/dL was a strong predictor of MACE (hazard ratio: 2.2, 95% confidence interval [CI]: 1.3-3.6, P = 0.002). Both diabetes mellitus and ACS were associated with hyperglycemia (glucose levels above 140 mg/dL). Nevertheless, the incidence of hyperglycemia was doubled in diabetic patients (odds ratio [OR]: 9.4, 95% CI: 3.9-22.4, P < 0.001) compared with patients with ACS (OR: 4.6, 95% CI: 2.3-9.0, P < 0.001). Combining both conditions was associated with a high likelihood of elevated glucose levels (OR: 15.5, 95% CI: 7.4-32.9, P < 0.001).
  
  
  CONCLUSIONS
  Hyperglycemia in patients undergoing cardiac catheterization is a strong predictor of adverse outcome. It is mainly related to background dysglycemia and to a lesser extent to the acute stress accompanying ACS.
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Arbel
authors.forename: Hezzy
authors.initials: H
authors.lastname: Shmueli
authors.forename: Amir
authors.initials: A
authors.lastname: Halkin
authors.forename: Shlomo
authors.initials: S
authors.lastname: Berliner
authors.forename: Itzhak
authors.initials: I
authors.lastname: Shapira
authors.forename: Itzhak
authors.initials: I
authors.lastname: Herz
authors.forename: Ofer
authors.initials: O
authors.lastname: Havakuk
authors.forename: Yacov
authors.initials: Y
authors.lastname: Shacham
authors.forename: Itay
authors.initials: I
authors.lastname: Rabinovich
authors.forename: Gad
authors.initials: G
authors.lastname: Keren
authors.forename: Ariel
authors.initials: A
authors.lastname: Finkelstein
authors.forename: Shmuel
authors.initials: S
authors.lastname: Banai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D006328:Cardiac Catheterization; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012017:Referral and Consultation; D012042:Registries; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human