Key result
Fasting hyperglycemia in non-diabetic ACS patients is linked to ~139% greater one-year mortality.
Why the study?
Does fasting hyperglycaemia at admission predict one-year mortality and incidence of diabetes in non-diabetic patients hospitalized with acute coronary syndrome?
Cohort (n=3,858)
Does fasting hyperglycaemia at admission predict one-year mortality and incidence of diabetes in non-diabetic patients hospitalized with acute coronary syndrome?
Hazard Ratio: 2.39 (95% CI 1.03–5.56)
Absolute Event Rate: 5.4% vs 2.2%
p-value: p=0.041
In non-diabetic patients presenting with acute coronary syndrome, fasting hyperglycaemia ⩾10 mmol/l is a strong predictor of one-year mortality and is associated with a four-fold increased risk of developing diabetes.
Should not yet guide glucose management in non-diabetic ACS; leaves open whether hyperglycaemia is a modifiable target.
Background: Controversy remains regarding the prevalence of hyperglycaemia in non-diabetic patients hospitalised with acute coronary syndrome and its prognostic value for long-term outcomes. Methods and results: We evaluated the prevalence of hyperglycaemia (defined as fasting glycaemia ⩾10 mmol/l) among patients with no known diabetes at the time of enrolment in the prospective Special Program University Medicine-Acute Coronary Syndromes cohort, as well as its impact on all-cause death, myocardial infarction, stroke and incidence of diabetes at one year. Among 3858 acute coronary syndrome patients enrolled between December 2009–December 2014, 709 (18.4%) had known diabetes, while 112 (3.6%) of non-diabetic patients had hyperglycaemia at admission. Compared with non-hyperglycaemic patients, hyperglycaemic individuals were more likely to present with ST-elevation myocardial infarction and acute heart failure. At discharge, hyperglycaemic patients were more frequently treated with glucose-lowering agents (8.9% vs 0.66%, p<0.001). At one-year, adjudicated all-cause death was significantly higher in non-diabetic patients presenting with hyperglycaemia compared with patients with no hyperglycaemia (5.4% vs 2.2%, p=0.041) and hyperglycaemia was a significant predictor of one-year mortality (adjusted hazard ratio 2.39, 95% confidence interval 1.03–5.56). Among patients with hyperglycaemia, 9.8% had developed diabetes at one-year, while the corresponding proportion among patients without hyperglycaemia was 1.8% (p<0.001). In multivariate analysis, hyperglycaemia at presentation predicted the onset of treated diabetes at one-year (odds ratio 4.15, 95% confidence interval 1.59–10.86; p=0.004). Conclusion: Among non-diabetic patients hospitalised with acute coronary syndrome, a fasting hyperglycaemia of ⩾10 mmol/l predicted one-year mortality and was associated with a four-fold increased risk of developing diabetes at one year.
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Gencer et al. (2018) conducted a cohort in Acute coronary syndrome (n=3,858). Fasting hyperglycaemia (≥10 mmol/l) vs. No hyperglycaemia was evaluated on All-cause death at one year (HR 2.39, 95% CI 1.03-5.56, p=0.041). Fasting hyperglycaemia (≥10 mmol/l) in non-diabetic patients with acute coronary syndrome was associated with increased one-year mortality (5.4% vs 2.2%; adjusted HR 2.39, 95% CI 1.03–5.56).
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