title: Blood glucose in acute coronary syndromes. How low should you go?
abstract: OBJECTIVE
  Hyperglycemia at admission seems to identify a subgroup of patients with acute coronary syndromes with poorer outcome. The aim of this study was to evaluate the impact of the glycemic variation during hospitalization in long-term mortality in nondiabetic patients.
  
  
  METHODS
  Retrospective study of 2043 consecutive patients without known diabetes mellitus admitted for acute coronary syndrome in a single coronary care unit from May 2007 through August 2013. The population was divided in quartiles regarding glycemia at admission (≤ 90 mg/dL, n = 374; 90-140 mg/dL, n = 1307; 141-180 mg/dL, n = 230; ≥ 181mg/dL, n = 111) and the mortality rate quantified for patients with glycemic variation above/below the mean for their respective quartile. The median follow-up was about 1200 days.
  
  
  RESULTS
  The all-cause mortality during follow-up was significantly and successively higher in the upper quartiles (9.1%, 9.7%, 13.5% and 18.9%; P = .007). Multivariate regression analysis showed that hyperglycemia at admission (≥ 181mg/dL) was a strong independent predictor of mortality during follow-up (hazard ratio = 1.74; 95% confidence interval, 1.07-2.8; P = .027). In the fourth quartile (≥ 181mg/dL), the mortality is higher in patients with higher variations of glycemia (37.5% vs 8.5%; P < .001).
  
  
  CONCLUSIONS
  Hyperglycemia at admission is a predictor of all-cause mortality in our population. The mortality is higher in patients with higher glycemic variations. More studies are needed to confirm these data.
authors.affiliation: Departamento de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. Electronic address: heliafortunamartins@gmail.com.
authors.forename: Hélia
authors.initials: H
authors.lastname: Martins
authors.affiliation: Departamento de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Sílvia
authors.initials: S
authors.lastname: Monteiro
authors.affiliation: Departamento de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Francisco
authors.initials: F
authors.lastname: Gonçalves
authors.affiliation: Departamento de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Monteiro
authors.affiliation: Departamento de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Mariano
authors.initials: M
authors.lastname: Pêgo
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000150:complications / Q000453:epidemiology; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D002423:Cause of Death / Q000639:trends; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011174:Portugal / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
chemical_list: D001786:Blood Glucose
keywords: Acute coronary syndrome; Alteración del metabolismo de la glucosa; Glucose dysmetabolism; Glycemic variation; Hiperglucemia de estrés; Stress hyperglycemia; Síndrome coronario agudo; Variación glucémica