Hyperglycemia and Adverse Outcomes in Acute Coronary Syndromes: Is Serum Glucose the Provocateur or Innocent Bystander?

Hyperglycemia at the time of hospital admission predicts increased mortality in patients with acute coronary syn-dromes (ACS), including ST-segment elevation myocardial infarction (STEMI) (1–6), revascularization procedures such as thrombolysis or percutaneous coronary interven-tion (PCI) (7–10), and other critical illnesses (11–13). The relationship between blood glucose and mortality appears linear with escalating risk associated with in-creasing blood glucose levels and is independent of a di-agnosis of diabetes (14). However, there is ongoing debate as to whether hyperglycemia directly contributes to the adverse outcomes or whether it is simply a marker of higher risk. There are three main hypotheses as to why hypergly-cemia portends higher mortality in acutely ill patients