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Association of elevated fasting glucose with increased short-term and 6-month mortality in ST-segment elevation and non-ST-segment elevation acute coronary syndromes: the Global Registry of Acute Coronary Events.
Arch Intern Med. 2009 Feb 23; 169(4):402-9.AI

Abstract

BACKGROUND

Elevated blood glucose level at admission is associated with worse outcome after a myocardial infarction. The impact of elevated glucose level, particularly fasting glucose, is less certain in non-ST-segment elevation acute coronary syndromes. We studied the relationship between elevated fasting blood glucose levels and outcome across the spectrum of ST-segment elevation and non-ST-segment elevation acute coronary syndromes in a large multicenter population broadly representative of clinical practice.

METHODS

Fasting glucose levels were available for 13 526 patients in the Global Registry of Acute Coronary Events. A multivariate logistic regression analysis was used for assessing the association between admission or fasting glucose level and in-hospital or 6-month outcome, adjusted for the variables from the registry risk scores.

RESULTS

Higher fasting glucose levels were associated with a graded increase in the risk of in-hospital death (odds ratios [95% confidence intervals] vs <100 mg/dL: 1.51 [1.12-2.04] for 100-125 mg/dL, 2.20 [1.64-2.60] for 126-199 mg/dL, 5.11 [3.52-7.43] for 200-299 mg/dL, and 8.00 [4.76-13.5] for > or =300 mg/dL). When taken as a continuous variable, higher fasting glucose level was related to a higher probability of in-hospital death, without detectable threshold and irrespective of whether patients had a history of diabetes mellitus. Higher fasting glucose levels were found to be associated with a higher risk of postdischarge death up to 6 months. The risk of postdischarge death at 6 months was significantly higher with fasting glucose levels between 126 and 199 mg/dL (1.71 [1.25-2.34]) and 300 mg/dL or greater (2.93 [1.33-6.43]), but not within the 200- to 299-mg/dL range (1.08 [0.60-1.95]).

CONCLUSIONS

Short-term and 6-month mortality was increased significantly with higher fasting glucose levels in patients across the spectrum of acute coronary syndromes, thus extending this relation to patients with non-ST-segment elevation myocardial infarction. The relation between fasting glucose level and risk of adverse short-term outcomes is graded across different glucose levels with no detectable threshold for diabetic or nondiabetic patients.

Authors+Show Affiliations

Department of Cardiology, University Hospitals Leuven Campus Gasthuisberg, Herestraat 49, Leuven, Belgium. peter.sinnaeve@uzleuven.be.No affiliation info availableNo affiliation info availableNo 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)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19237725

Citation

Sinnaeve, Peter R., et al. "Association of Elevated Fasting Glucose With Increased Short-term and 6-month Mortality in ST-segment Elevation and non-ST-segment Elevation Acute Coronary Syndromes: the Global Registry of Acute Coronary Events." Archives of Internal Medicine, vol. 169, no. 4, 2009, pp. 402-9.
Sinnaeve PR, Steg PG, Fox KA, et al. Association of elevated fasting glucose with increased short-term and 6-month mortality in ST-segment elevation and non-ST-segment elevation acute coronary syndromes: the Global Registry of Acute Coronary Events. Arch Intern Med. 2009;169(4):402-9.
Sinnaeve, P. R., Steg, P. G., Fox, K. A., Van de Werf, F., Montalescot, G., Granger, C. B., Knobel, E., Anderson, F. A., Dabbous, O. H., & Avezum, A. (2009). Association of elevated fasting glucose with increased short-term and 6-month mortality in ST-segment elevation and non-ST-segment elevation acute coronary syndromes: the Global Registry of Acute Coronary Events. Archives of Internal Medicine, 169(4), 402-9. https://doi.org/10.1001/archinternmed.2008.572
Sinnaeve PR, et al. Association of Elevated Fasting Glucose With Increased Short-term and 6-month Mortality in ST-segment Elevation and non-ST-segment Elevation Acute Coronary Syndromes: the Global Registry of Acute Coronary Events. Arch Intern Med. 2009 Feb 23;169(4):402-9. PubMed PMID: 19237725.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of elevated fasting glucose with increased short-term and 6-month mortality in ST-segment elevation and non-ST-segment elevation acute coronary syndromes: the Global Registry of Acute Coronary Events. AU - Sinnaeve,Peter R, AU - Steg,P Gabriel, AU - Fox,Keith A A, AU - Van de Werf,Frans, AU - Montalescot,Gilles, AU - Granger,Christopher B, AU - Knobel,Elias, AU - Anderson,Frederick A, AU - Dabbous,Omar H, AU - Avezum,Alvaro, AU - ,, PY - 2009/2/25/entrez PY - 2009/2/25/pubmed PY - 2009/3/10/medline SP - 402 EP - 9 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 169 IS - 4 N2 - BACKGROUND: Elevated blood glucose level at admission is associated with worse outcome after a myocardial infarction. The impact of elevated glucose level, particularly fasting glucose, is less certain in non-ST-segment elevation acute coronary syndromes. We studied the relationship between elevated fasting blood glucose levels and outcome across the spectrum of ST-segment elevation and non-ST-segment elevation acute coronary syndromes in a large multicenter population broadly representative of clinical practice. METHODS: Fasting glucose levels were available for 13 526 patients in the Global Registry of Acute Coronary Events. A multivariate logistic regression analysis was used for assessing the association between admission or fasting glucose level and in-hospital or 6-month outcome, adjusted for the variables from the registry risk scores. RESULTS: Higher fasting glucose levels were associated with a graded increase in the risk of in-hospital death (odds ratios [95% confidence intervals] vs <100 mg/dL: 1.51 [1.12-2.04] for 100-125 mg/dL, 2.20 [1.64-2.60] for 126-199 mg/dL, 5.11 [3.52-7.43] for 200-299 mg/dL, and 8.00 [4.76-13.5] for > or =300 mg/dL). When taken as a continuous variable, higher fasting glucose level was related to a higher probability of in-hospital death, without detectable threshold and irrespective of whether patients had a history of diabetes mellitus. Higher fasting glucose levels were found to be associated with a higher risk of postdischarge death up to 6 months. The risk of postdischarge death at 6 months was significantly higher with fasting glucose levels between 126 and 199 mg/dL (1.71 [1.25-2.34]) and 300 mg/dL or greater (2.93 [1.33-6.43]), but not within the 200- to 299-mg/dL range (1.08 [0.60-1.95]). CONCLUSIONS: Short-term and 6-month mortality was increased significantly with higher fasting glucose levels in patients across the spectrum of acute coronary syndromes, thus extending this relation to patients with non-ST-segment elevation myocardial infarction. The relation between fasting glucose level and risk of adverse short-term outcomes is graded across different glucose levels with no detectable threshold for diabetic or nondiabetic patients. SN - 1538-3679 UR - https://www.unboundmedicine.com/medline/citation/19237725/Association_of_elevated_fasting_glucose_with_increased_short_term_and_6_month_mortality_in_ST_segment_elevation_and_non_ST_segment_elevation_acute_coronary_syndromes:_the_Global_Registry_of_Acute_Coronary_Events_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinternmed.2008.572 DB - PRIME DP - Unbound Medicine ER -