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Impact of Admission Glucose Level and Presence of Diabetes Mellitus on Mortality in Patients With Non–ST-Segment Elevation Acute Coronary Syndrome Treated Conservatively

2009; Elsevier BV; Volume: 103; Issue: 7 Linguagem: Inglês

10.1016/j.amjcard.2008.12.008

1879-1913

Artur Dziewierz, Dawid Giszterowicz, Zbigniew Siudak, Tomasz Rakowski, Waldemar Mielecki, M Suska, Jacek S. Dubiel, Dariusz Dudek,

Acute Myocardial Infarction Research

Elevated glucose level on admission is common in patients with acute coronary syndrome (ACS) and has been shown to be a strong predictor of adverse outcome in patients both with and without diabetes. The purpose of the study was to assess the impact of admission glucose on in-hospital mortality in patients with non–ST-segment elevation ACS treated in hospitals without on-site invasive facilities. We identified 807 patients with non–ST-segment elevation ACS treated conservatively in the 29 hospitals participating in the Krakow Registry of Acute Coronary Syndromes; 763 patients with complete admission glucose data were stratified according to admission glucose level. Of these, 24.2% had admission glucose level <5, 50.6% had a level 5 to 6.9, 10.9% had a level 7 to 8.9, 6.7% had a level 9 to 10.9, and 7.6% had a level ≥11 mmol/L. In-hospital mortality was higher in patients with higher admission glucose (admission glucose <5, 5 to 6.9, 7 to 8.9, 9 to 10.9, and ≥11 mmol/L: 0.5%, 2.6%, 7.2%, 9.8%, and 24.1% respectively, p <0.0001). Similarly, significant mortality difference was observed in patient subgroups stratified by admission glucose level and presence of diabetes mellitus and cardiogenic shock. Independent predictors of in-hospital death were age, cardiogenic shock, admission glucose, chronic obstructive pulmonary disease, and renal insufficiency. In conclusion, admission glucose level is a strong predictor of in-hospital death in patients with non–ST-segment elevation ACS remaining in hospitals without on-site invasive facilities. Impact of admission glucose on mortality is independent of diabetes and cardiogenic shock presence. Elevated glucose level on admission is common in patients with acute coronary syndrome (ACS) and has been shown to be a strong predictor of adverse outcome in patients both with and without diabetes. The purpose of the study was to assess the impact of admission glucose on in-hospital mortality in patients with non–ST-segment elevation ACS treated in hospitals without on-site invasive facilities. We identified 807 patients with non–ST-segment elevation ACS treated conservatively in the 29 hospitals participating in the Krakow Registry of Acute Coronary Syndromes; 763 patients with complete admission glucose data were stratified according to admission glucose level. Of these, 24.2% had admission glucose level <5, 50.6% had a level 5 to 6.9, 10.9% had a level 7 to 8.9, 6.7% had a level 9 to 10.9, and 7.6% had a level ≥11 mmol/L. In-hospital mortality was higher in patients with higher admission glucose (admission glucose <5, 5 to 6.9, 7 to 8.9, 9 to 10.9, and ≥11 mmol/L: 0.5%, 2.6%, 7.2%, 9.8%, and 24.1% respectively, p <0.0001). Similarly, significant mortality difference was observed in patient subgroups stratified by admission glucose level and presence of diabetes mellitus and cardiogenic shock. Independent predictors of in-hospital death were age, cardiogenic shock, admission glucose, chronic obstructive pulmonary disease, and renal insufficiency. In conclusion, admission glucose level is a strong predictor of in-hospital death in patients with non–ST-segment elevation ACS remaining in hospitals without on-site invasive facilities. Impact of admission glucose on mortality is independent of diabetes and cardiogenic shock presence.