Impact of Admission Glucose Level and Presence of Diabetes Mellitus on Mortality in Patients With Non–ST-Segment Elevation Acute Coronary Syndrome Treated Conservatively
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- 作者：Artur Dziewierz ; Dawid Giszterowicz ; Zbigniew Siudak ; Tomasz Rakowski ; Waldemar Mielecki ; Marcin Suska ; Jacek S. Dubiel ; Dariusz Dudek
- 刊名：The American Journal of Cardiology
- 出版年：2009
- 出版时间：1 April 2009
- 年：2009
- 卷：103
- 期：7
- 页码：954-958
- 全文大小：560 K
文摘
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.