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Admission glycaemia and outcome in patients with acute coronary syndrome

Acute myocardial infarction and unstable angina in Switzerland (AMIS Plus) Data Center, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.

Dragana Radovanovic

Acute myocardial infarction and unstable angina in Switzerland (AMIS Plus) Data Center, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.

Edoardo Camenzind

Division of Cardiology, University Hospital, Geneva, Switzerland.

Manfred Essig

Department of Medicine, Hospital Zweisimmen, Zweisimmen, Switzerland.

Osmund Bertel

Division of Cardiology, Stadtspital Triemli, Zurich, Switzerland.

Paul Erne

Division of Cardiology, Kantonsspital, Lucerne, Switzerland.

Franz Robert Eberli

Division of Cardiology, University Hospital, Zurich, Switzerland.

Felix Gutzwiller

Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.

Some studies of patients with acute myocardial infarction have reported that hyperglycaemia at admission may be associated with a worse outcome. This study sought to evaluate the association of blood glucose at admission with the outcome of unselected patients with acute coronary syndrome (ACS).

Using the Acute Myocardial Infarction and unstable angina in Switzerland (AMIS Plus) registry, ACS patients were stratified according to their blood glucose on admission: group 1: 2.80–6.99 mmol/L, group 2: 7.00–11.09 mmol/L and group 3: 11.10 mmol/L. Odds ratios for in-hospital mortality were calculated using logistic regression models.

Of 2,786 patients, 73% were male and 21% were known to have diabetes. In-hospital mortality increased from 3% in group 1 to 7% in group 2 and to 15% in group 3. Higher glucose levels were associated with larger enzymatic infarct sizes (p<0.001) and had a weak negative correlation with angiographic or echographic left ventricular ejection fraction. High admission glycaemia in ACS patients remains a significant independent predictor of in-hospital mortality (adjusted OR 1.08; 95% confidence intervals [CI] 1.05–1.14, p<0.001) per mmol/L. The OR for in-hospital mortality was 1.04 (95% CI 0.99–1.1; p=0.140) per mmol/L for patients with diabetes but 1.21 (95% CI 112–1.30; p<0.001) per mmol/L for non-diabetic patients.

In conclusion, elevated glucose level in ACS patients on admission is a significant independent predictor of in-hospital mortality and is even more important for patients who do not have known diabetes.

Key Words: acute coronary syndrome • admission glycaemia • diabetes • gender • hyperglycaemia • outcome

Diabetes and Vascular Disease Research, Vol. 4, No. 4, 346-352 (2007)
DOI: 10.3132/dvdr.2007.063


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