title: One-year mortality in elderly adults with non-ST-elevation acute coronary syndrome: effect of diabetic status and admission hyperglycemia.
abstract: OBJECTIVE
  To determine whether type 2 diabetes mellitus and hyperglycemia on admission should be considered independent predictors of mortality in elderly adults with acute coronary syndrome (ACS).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Twenty-three hospitals in Italy.
  
  
  METHODS
  Individuals aged 75 and older with non-ST-elevation ACS (NSTEACS) (mean age 82, 47% female) (N = 645).
  
  
  METHODS
  Diabetic status and blood glucose levels were assessed on admission. Hyperglycemia was defined as glucose greater than 140 mg/dL. Multivariable Cox proportional hazard regression was used to assess the potential confounding effect of major covariates on the association between diabetic status, admission glucose, and 1-year mortality.
  
  
  RESULTS
  A history of diabetes mellitus was found in 231 participants (35.8%), whereas 257 (39.8%) had hyperglycemia. Hyperglycemia was found in 171 participants with diabetes mellitus (70%) and 86 (21%) without diabetes mellitus. Participants with diabetes mellitus were significantly (P < .05) more likely to have had prior myocardial infarction and stroke and had lower ejection fraction and blood hemoglobin. Hyperglycemia was associated with lower (P < .05) ejection fraction and estimated glomerular filtration rate (eGFR). Diabetic status and hyperglycemia were associated with greater 1-year mortality according to univariate analysis (54 participants with diabetes mellitus died (23.4%), versus 66 (15.9%) without diabetes mellitus (hazard ratio (HR) = 1.5 95% confidence interval (CI) = 1.0-2.1), and 60 participants with hyperglycemia died (23.3%), versus 60 (15.5%) without hyperglycemia (HR=1.6; 95% CI = 1.1-2.2), but this association was not statistically significant after adjustment for ejection fraction, age, blood hemoglobin, and eGFR.
  
  
  CONCLUSIONS
  In elderly adults with NSTEACS, diabetes mellitus and hyperglycemia on admission are associated with higher mortality, mostly because of preexisting cardiovascular and renal damage.
authors.affiliation: Division of Cardiology, A. Manzoni Hospital, Lecco, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Savonitto
authors.forename: Nuccia
authors.initials: N
authors.lastname: Morici
authors.forename: Claudio
authors.initials: C
authors.lastname: Cavallini
authors.forename: Roberto
authors.initials: R
authors.lastname: Antonicelli
authors.forename: Anna Sonia
authors.initials: AS
authors.lastname: Petronio
authors.forename: Ernesto
authors.initials: E
authors.lastname: Murena
authors.forename: Zoran
authors.initials: Z
authors.lastname: Olivari
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Steffenino
authors.forename: Francesco
authors.initials: F
authors.lastname: Bonechi
authors.forename: Antonio
authors.initials: A
authors.lastname: Mafrici
authors.forename: Anna
authors.initials: A
authors.lastname: Toso
authors.forename: Federico
authors.initials: F
authors.lastname: Piscione
authors.forename: Leonardo
authors.initials: L
authors.lastname: Bolognese
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000401:mortality*; D000368:Aged; D048909:Diabetes Complications / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors
keywords: acute coronary syndrome; diabetes mellitus; elderly; hyperglycemia; mortality