Key result
In patients with acute coronary syndromes, admission glycaemia ≥5.77 mmol/l was an independent predictor of in-hospital mortality, particularly in non-diabetic patients.
Why the study?
Does elevated admission glycaemia predict short- and long-term mortality in diabetic and non-diabetic patients with acute coronary syndromes?
Cohort (n=1,149)
No
Does elevated admission glycaemia predict short- and long-term mortality in diabetic and non-diabetic patients with acute coronary syndromes?
Admission hyperglycemia is a strong independent predictor of short- and long-term mortality in patients with acute coronary syndromes, particularly among those without known diabetes.
Answers are grounded in this paper and cite their sources.
May aid ACS risk stratification by admission glucose; leaves open whether targeting hyperglycemia improves outcomes in non-diabetics.
OBJECTIVE: To evaluate the impact of admission glycaemia on short-term and long-term prognosis in diabetic and non-diabetic patients admitted for acute coronary syndromes (ACS), and to identify the independent predictors of post-ACS mortality in this population. METHODS: This study included 1149 consecutive patients admitted to a single coronary care unit for ACS between May 2004 and December 2006. Our population was divided into four groups according to the quartiles of glycaemia at admission [Q1 <5.77 mmol/l, Q2 (5.77-7.0) mmol/l, Q3 (7.0-9.22) mmol/l and Q4 > or =9.22 mmol/l]. Diabetic (n = 396) and non-diabetic (n = 753) subgroups were then separately analysed. RESULTS: Hyperglycaemia at admission was associated with worse cardiovascular risk profile, high levels of necrosis and inflammation biomarkers and low left ventricle ejection fraction. Considering overall population, in-hospital, 30-day and 3-year mortalities were higher in more elevated glycaemia quartiles. In diabetic patients, there were no significant differences in mortality among glycaemia quartiles; however, in non-diabetic group higher admission glucose levels were associated with successively higher in-hospital and 3-year mortalities. After multivariate regression analysis, glycaemia at admission > or =5.77 mmol/l, age > or =72 years, Killip class >1 and troponin I > or =6.0 ng/ml were independent predictors of in-hospital mortality. CONCLUSION: This study suggests that, in a broad ACS population, hyperglycaemia at admission is a short-term and long-term bad prognosis marker, particularly in non-diabetic patients, being a strong independent predictor of in-hospital mortality.
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Monteiro et al. (2010) conducted a cohort in acute coronary syndromes (n=1,149). Hyperglycaemia at admission vs. Lower admission glycaemia (<5.77 mmol/l) was evaluated on In-hospital, 30-day and 3-year mortality. In patients with acute coronary syndromes, admission glycaemia ≥5.77 mmol/l was an independent predictor of in-hospital mortality, particularly in non-diabetic patients.
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