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[Influence of admission glucose level on long-term prognosis in patients with acute coronary syndrome].
Rev Esp Cardiol. 2006 Dec; 59(12):1268-75.RE

Abstract

INTRODUCTION AND OBJECTIVES

Hyperglycemia can increase the risk of death or a poor outcome following myocardial infarction. Our objective was to investigate the value of the admission glucose level in predicting long-term outcome in patients with acute coronary syndrome.

METHODS

The study population comprised 565 patients admitted with acute coronary syndrome within 24 hours of the start of symptoms. The final diagnosis was myocardial infarction in 56% and unstable angina in 44%.

RESULTS

The patients' mean glucose level was 143 (77) mg/dL. During follow-up (42 [6] months), 55 (9.7%) patients died. The area under the receiver operating characteristic curve for the optimum cut point for predicting death from the glucose level was 0.67; the cut point was 128 mg/dL, with a sensitivity of 85% and a specificity of 62%. Patients were divided into 2 groups according to blood glucose level: in group 1 (36.8%), it was > or = 128 mg/dL; in group 2, <128 mg/dL. There were differences between the groups in the incidence of diabetes (47.2% vs 12.6%; P< .001), systolic blood pressure (138 [33] mm Hg vs 133 [33] mm Hg; P< .001), and ejection fraction (48.3 [0.9]% vs 55.2 [12.4]%; P=.004). At 4 years, the survival rates were 40% and 77% in groups 1 and 2, respectively (log rank test P< .001). The following were independent predictors of mortality: admission glucose level > or =128 mg/dL (hazard ratio [HR= 2.41; P=.021), admission systolic blood pressure (HR= 0.97; P< .001), admission troponin-T level (HR=4.88; P< .001), and the development of heart failure (HR=1.04; P=.001). A rise of 10 mg/dL in glucose level was associated with a 2.56-fold increase in the risk of death (P=.012).

CONCLUSIONS

In patients with acute coronary syndrome, hyperglycemia at admission (cut point > or =128 mg/dL) was associated with increased long-term risk and, in addition, was a strong independent predictor of mortality.

Authors+Show Affiliations

Unidad de Cuidados Intensivos Coronarios, Instituto de Cardiología Juana F. Cabral, Corrientes, Argentina. macinucic@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

spa

PubMed ID

17194422

Citation

Macín, Stella M., et al. "[Influence of Admission Glucose Level On Long-term Prognosis in Patients With Acute Coronary Syndrome]." Revista Espanola De Cardiologia, vol. 59, no. 12, 2006, pp. 1268-75.
Macín SM, Perna ER, Coronel ML, et al. [Influence of admission glucose level on long-term prognosis in patients with acute coronary syndrome]. Rev Esp Cardiol. 2006;59(12):1268-75.
Macín, S. M., Perna, E. R., Coronel, M. L., Kriskovich, J. O., Bayol, P. A., Franciosi, V. A., Riera-Stival, J. L., González-Arjol, B., & Badaracco, J. R. (2006). [Influence of admission glucose level on long-term prognosis in patients with acute coronary syndrome]. Revista Espanola De Cardiologia, 59(12), 1268-75.
Macín SM, et al. [Influence of Admission Glucose Level On Long-term Prognosis in Patients With Acute Coronary Syndrome]. Rev Esp Cardiol. 2006;59(12):1268-75. PubMed PMID: 17194422.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Influence of admission glucose level on long-term prognosis in patients with acute coronary syndrome]. AU - Macín,Stella M, AU - Perna,Eduardo R, AU - Coronel,María L, AU - Kriskovich,Jorge O, AU - Bayol,Pablo A, AU - Franciosi,Valeria A, AU - Riera-Stival,Jorge L, AU - González-Arjol,Bilda, AU - Badaracco,Jorge R, PY - 2006/12/30/pubmed PY - 2007/3/21/medline PY - 2006/12/30/entrez SP - 1268 EP - 75 JF - Revista espanola de cardiologia JO - Rev Esp Cardiol VL - 59 IS - 12 N2 - INTRODUCTION AND OBJECTIVES: Hyperglycemia can increase the risk of death or a poor outcome following myocardial infarction. Our objective was to investigate the value of the admission glucose level in predicting long-term outcome in patients with acute coronary syndrome. METHODS: The study population comprised 565 patients admitted with acute coronary syndrome within 24 hours of the start of symptoms. The final diagnosis was myocardial infarction in 56% and unstable angina in 44%. RESULTS: The patients' mean glucose level was 143 (77) mg/dL. During follow-up (42 [6] months), 55 (9.7%) patients died. The area under the receiver operating characteristic curve for the optimum cut point for predicting death from the glucose level was 0.67; the cut point was 128 mg/dL, with a sensitivity of 85% and a specificity of 62%. Patients were divided into 2 groups according to blood glucose level: in group 1 (36.8%), it was > or = 128 mg/dL; in group 2, <128 mg/dL. There were differences between the groups in the incidence of diabetes (47.2% vs 12.6%; P< .001), systolic blood pressure (138 [33] mm Hg vs 133 [33] mm Hg; P< .001), and ejection fraction (48.3 [0.9]% vs 55.2 [12.4]%; P=.004). At 4 years, the survival rates were 40% and 77% in groups 1 and 2, respectively (log rank test P< .001). The following were independent predictors of mortality: admission glucose level > or =128 mg/dL (hazard ratio [HR= 2.41; P=.021), admission systolic blood pressure (HR= 0.97; P< .001), admission troponin-T level (HR=4.88; P< .001), and the development of heart failure (HR=1.04; P=.001). A rise of 10 mg/dL in glucose level was associated with a 2.56-fold increase in the risk of death (P=.012). CONCLUSIONS: In patients with acute coronary syndrome, hyperglycemia at admission (cut point > or =128 mg/dL) was associated with increased long-term risk and, in addition, was a strong independent predictor of mortality. SN - 1579-2242 UR - https://www.unboundmedicine.com/medline/citation/17194422/[Influence_of_admission_glucose_level_on_long_term_prognosis_in_patients_with_acute_coronary_syndrome]_ L2 - http://www.revespcardiol.org/en/linksolver/ft/ivp/0300-8932/59/1268 DB - PRIME DP - Unbound Medicine ER -