title: Admission plasma glucose levels within the normal to mildly impaired range and the outcome of patients with acute coronary syndrome.
abstract: BACKGROUND
  Elevated admission plasma glucose levels >140 mg/dl are associated with adverse clinical outcomes in both diabetic and non-diabetic patients admitted with acute coronary syndrome (ACS). We aimed to evaluate the association between admission plasma glucose levels <140 mg/dl and the outcome of non-diabetic patients admitted with acute coronary syndrome.
  
  
  METHODS
  The study population consisted of patients with acute coronary syndrome included in the Acute Coronary Syndrome Israeli Survey during 2000-2013. Diabetic patients were excluded. The primary endpoint was all-cause mortality at one year.
  
  
  RESULTS
  The 452 0 patients had a mean age of 61.7±13.5 years and were stratified into four quartiles according to admission plasma glucose (60-94, 95-105, 106-119, 120-140 mg/dl). Patients with higher admission plasma glucose were older and included a higher percentage of smokers. In addition, the higher the glucose so also did they have a poorer risk factor profile including a higher body mass index, total and low-density lipoprotein cholesterol and triglyceride levels, and lower high-density lipoprotein cholesterol levels. During the first year 5.2% of patients died. A comparison of one-year mortality according to admission plasma glucose quartiles demonstrated a significant and progressive increase in mortality risk as admission plasma glucose rose (3.5%, 4.1%, 6.1%, 6.4%, respectively, p=0.001). However, this association lost its clinical significance following a multivariate analysis ( p=0.08).
  
  
  CONCLUSIONS
  High admission plasma glucose levels within the normal to mildly impaired range are associated with increased one-year mortality in non-diabetic acute coronary syndrome patients. However, the higher glucose level is probably not the cause for the adverse outcome but rather a marker for high risk. Our findings support the definition of 140 mg/dl as the cutoff for clinically acceptable admission glucose levels in patients with acute coronary syndrome.
authors.affiliation: 1 Department of Cardiology, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Kirill
authors.initials: K
authors.lastname: Buturlin
authors.affiliation: 2 Cardiology Department, Assaf-Harofeh Medical Center, Zerifin, Israel.
authors.forename: Saar
authors.initials: S
authors.lastname: Minha
authors.affiliation: 3 Department of Internal Medicine D, Tel Aviv Sourasky Medical Center, Israel.
authors.forename: Zach
authors.initials: Z
authors.lastname: Rozenbaum
authors.affiliation: 1 Department of Cardiology, Meir Medical Center, Kfar Saba, Israel.|4 Sackler Faculty of Medicine, Tel-Aviv University, Israel.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Neuman
authors.affiliation: 5 Department of Cardiology, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Meital
authors.initials: M
authors.lastname: Shlezinger
authors.affiliation: 4 Sackler Faculty of Medicine, Tel-Aviv University, Israel.|5 Department of Cardiology, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: 1 Department of Cardiology, Meir Medical Center, Kfar Saba, Israel.|4 Sackler Faculty of Medicine, Tel-Aviv University, Israel.
authors.forename: Morris
authors.initials: M
authors.lastname: Mosseri
authors.affiliation: 1 Department of Cardiology, Meir Medical Center, Kfar Saba, Israel.|4 Sackler Faculty of Medicine, Tel-Aviv University, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Pereg
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D002423:Cause of Death / Q000639:trends; D003325:Coronary Care Units; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007297:Inpatients; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose
keywords: Glucose; acute coronary syndrome; mortality