Valor pronóstico de la primera glucemia en ayunas en comparación con la glucemia al ingreso en pacientes con síndrome coronario agudo

doi:10.1157/13119988

Revista Española de Cardiología

Volume 61, Issue 5, May 2008, Pages 458-464

https://doi.org/10.1157/13119988 Get rights and content

Introducción y objetivos

La glucemia al ingreso (GI) es un factor pronóstico conocido en el síndrome coronario agudo (SCA), pero hay poca información acerca del valor de la primera glucemia en ayunas (PGA). Este estudio analiza el valor pronóstico de la PGA en pacientes con SCA comparado con el de la GI.

Métodos

Se analizó a los 547 pacientes que ingresaron consecutivamente en nuestro centro con el diagnóstico de SCA en el año 2006. Las cifras de GI y PGA fueron estratificadas en tres niveles (< 126, 126-200 y > 200 mg/dl). El objetivo primario del estudio fue el evento combinado de muerte y/o reinfarto durante la hospitalización.

Resultados

El desenlace principal ocurrió en 46 pacientes (25 muertes). Los pacientes de este grupo eran de mayor edad, más frecuentemente diabéticos, fumadores, con infarto de miocardio previo, con superior clase Killip durante el ingreso, con afección de más de un vaso en la coronariografía, con menor fracción de eyección y mayores creatinina al ingreso, GI y PGA. En el análisis multivariable ajustado por las variables anteriores, la PGA se mostró como predictor independiente de muerte y/o reinfarto (126-200 mg/dl, odds ratio [OR] = 5,26; intervalo de confianza [IC] del 95%, 1,09-25,45; > 200 mg/dl, OR = 6,66; IC del 95%, 2,05-21,63), no así la GI (126-200 mg/dl, OR = 0,84; IC del 95%, 0,63-1,05; > 200 mg/dl, OR = 1,14; IC del 95%, 0,29-4,51).

Conclusiones

La PGA se mostró mejor predictor de eventos adversos (muerte y/o reinfarto) que la GI en pacientes con SCA durante la hospitalización.

Introduction and objectives

The admission plasma glucose (APG) level is a recognized prognostic factor in patients with acute coronary syndrome (ACS). However, little is known about the prognostic value of the first fasting plasma glucose (FPG) measurement. The aim of this study was to determine the prognostic value of the first FPG measurement relative to that of the APG level in patients with ACS.

Methods

The study involved 547 consecutive patients who were admitted to our center with a diagnosis of ACS in 2006. Patients were divided into three groups according to their first FPG or APG level (i.e., <126 mg/dL, 126-200 mg/dL, or >200 mg/dL). The primary endpoint was the combined outcome of death or reinfarction during hospitalization.

Results

The primary endpoint was observed in 46 patients, 25 of whom died. Patients in this group were older, were more often diabetics or smokers, more often had had a prior myocardial infarction, were in a higher admission Killip class, showed more than one vessel disease on catheterization, had a lower left ventricular ejection fraction, and had higher admission creatinine, APG, and first FPG levels. Multivariate analysis, adjusted for previously identified factors, revealed that the first FPG level was an independent risk factor for death or reinfarction (126-200 mg/dL, odds ratio [OR]=5.26; 95% confidence interval [CI], 1.09-25.45; >200 mg/dL, OR=6.66; 95% CI, 2.05-21.63), but that the APG level was not (126-200 mg/dL, OR=0.84; 95% CI, 0.63-1.05; >200 mg/dL, OR=1.14; 95% CI, 0.29-4.51).

Conclusions

The first FPG level was found to be a better predictor of an adverse outcome (i.e., death or reinfarction) during hospitalization in ACS patients than the APG level.

Section snippets

INTRODUCCIÓN

La diabetes mellitus (DM) es uno de los factores conocidos de riesgo cardiovascular más importantes. El riesgo de enfermedad cardiovascular en pacientes diabéticos es al menos 2-4 veces el de los sujetos no diabéticos con una edad similar¹. Este hecho es de gran importancia, puesto que se prevé un aumento en la prevalencia de DM para los próximos 30 años y hasta un 75% de estos pacientes fallecerá a consecuencia de enfermedad coronaria². Por otro lado, la enfermedad coronaria en los pacientes

Población del estudio

Se diseñó un estudio de cohortes histórico, en el que se analizó a todos los pacientes que fueron admitidos de forma consecutiva entre enero y diciembre de 2006 en la Unidad Coronaria del Hospital Clínico San Carlos de Madrid con el diagnóstico de síndrome coronario agudo.

Los criterios de inclusión comprendían a todo paciente ingresado con un SCA, con o sin elevación del segmento ST, definido según las guías de práctica clínica actuales como al menos un episodio de dolor torácico o síntomas

RESULTADOS

Durante el año 2006, en total 558 pacientes ingresaron en nuestra unidad coronaria con el diagnóstico de SCA. De éstos, se excluyó a 11:5 que presentaron parada cardiorrespiratoria prehospitalaria recuperada y 6 que fallecieron en las primeras horas antes de poder tener ambos valores de glucemia. En total, 547 pacientes cumplieron los criterios de inclusión, de los que 46 sufrieron el desenlace principal de interés del estudio (muertes = 25). Las características demográficas, clínicas y el

DISCUSIÓN

Nuestros resultados refuerzan la importancia pronóstica de la DM y de los estados de hiperglucemia en los pacientes que sufren un SCA1., 3.. En efecto, los pacientes con muerte y/o reinfarto durante su hospitalización presentaban mayor prevalencia de DM, así como cifras de GI y PGA más elevadas; además, en nuestros pacientes la PGA se mostró como un factor predictor de eventos adversos mejor que la GI.

Aunque los últimos estudios ya consideran la DM como un equivalente de enfermedad

CONCLUSIONES

Con este estudio se muestra que los valores de la PGA en pacientes que han sufrido un SCA con o sin elevación del segmento ST predicen mejor que la GI el desarrollo de eventos adversos durante la hospitalización. Esto orienta a que la PGA es un mejor indicador de la alteración del estado metabólico en los primeros días de un SCA. Nuestros resultados respaldan que se siga investigando el manejo óptimo de la hiperglucemia en estos pacientes.

Bibliografía (30)

S. Capes et al.
Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview
Lancet
(2000)
D.K. McGuire et al.
Association of diabetes mellitus and glycemic control strategies with clinical outcomes after acute coronary syndromes
Am Heart J
(2004)
S.M. Macin et al.
Influencia de la concentración de glucemia en el momento del ingreso en la evolución a largo plazo de los pacientes con síndrome coronario agudo
Rev Esp Cardiol
(2006)
P. Petursson et al.
Admission glycaemia and outcome after acute coronary syndrome
Int J Cardiol
(2007)
J.R. Timmer et al.
Prognostic value of admission glucose in non-diabetic patients with myocardial infarction
Am Heart J
(2004)
A. Norhammar et al.
Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study
Lancet
(2002)
T. Killip et al.
Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patient
Am J Cardiol
(1967)
K. Malmberg et al.
Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year
J Am Coll Cardiol
(1995)
D.J. Angiolillo et al.
Insulin therapy is associated with platelet dysfunction in patients with type 2 diabetes mellitus on dual oral antiplatelet treatment
J Am Coll Cardiol
(2006)
T.S. Fergus et al.
Presentation, management and outcomes of diabetic patients compared to non-diabetic patients admitted for acute coronary syndromes
Heart
(2004)

S. Wild et al.

Global prevalence of diabetes. Estimates for the year 2000 and projections for 2030

Diabetes Care

(2004)

C. Nelson et al.

Blood glucose and coronary artery disease in nondiabetic patients

Diabetes Care

(2006)

T. Ainla et al.

The association between hyperglycaemia on admission and 180-day mortality in acute myocardial infarction patients with and without diabetes

Diabet Med

(2005)

I. Stranders et al.

Admission blood glucose level as risk indicator of death after myocardial infarction in patients with and without diabetes mellitus

Arch Intern Med

(2004)

M. Kosiborod et al.

Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes

Circulation

(2005)

Cited by (22)

Blood glucose in acute coronary syndromes. How low should you go?
2015, Revista Espanola de Cardiologia
La hiperglucemia al ingreso parece identificar a un subgrupo de pacientes con síndromes coronarios agudos que muestran una peor evolución clínica. El objetivo de este estudio es evaluar la influencia de la variación de la glucemia durante la hospitalización en la mortalidad a largo plazo de los pacientes no diabéticos.
Estudio retrospectivo de 2.043 pacientes consecutivos sin diabetes mellitus conocida que ingresaron por un síndrome coronario agudo en una misma unidad coronaria entre mayo de 2007 y agosto de 2013. La población se dividió en cuartiles en función de los valores de glucemia al ingreso (≤ 90 mg/dl, n = 374; 90-140 mg/dl, n = 1.307; 141-180 mg/dl, n = 230; ≥ 181 mg/dl, n = 111) y se determinó la tasa de mortalidad de los pacientes con variaciones de la glucemia por encima o por debajo de la media de su respectivo cuartil. La mediana de seguimiento fue de aproximadamente 1.200 días.
La mortalidad por cualquier causa durante el seguimiento fue sucesiva y significativamente mayor en los cuartiles superiores (el 9,1, el 9,7, el 13,5 y el 18,9%; p = 0,007). El análisis de regresión multivariable puso de manifiesto que la hiperglucemia al ingreso (≥ 181 mg/dl) es un potente factor independiente predictivo de la mortalidad durante el seguimiento (hazard ratio = 1,74; intervalo de confianza del 95%, 1,07-2,8; p = 0,027). En el cuarto cuartil (≥ 181 mg/dl), la mortalidad fue superior entre los pacientes con mayores variaciones de la glucemia (el 37,5 frente al 8,5%; p < 0,001).
La hiperglucemia al ingreso es un factor predictivo de la mortalidad por cualquier causa en nuestra población. La mortalidad es más elevada entre los pacientes con mayores variaciones de la glucemia. Se necesitan más estudios para confirmar estos datos.
Hyperglycemia at admission seems to identify a subgroup of patients with acute coronary syndromes with poorer outcome. The aim of this study was to evaluate the impact of the glycemic variation during hospitalization in long-term mortality in nondiabetic patients.
Retrospective study of 2043 consecutive patients without known diabetes mellitus admitted for acute coronary syndrome in a single coronary care unit from May 2007 through August 2013. The population was divided in quartiles regarding glycemia at admission (≤ 90 mg/dL, n = 374; 90-140 mg/dL, n = 1307; 141-180 mg/dL, n = 230; ≥ 181 mg/dL, n = 111) and the mortality rate quantified for patients with glycemic variation above/below the mean for their respective quartile. The median follow-up was about 1200 days.
The all-cause mortality during follow-up was significantly and successively higher in the upper quartiles (9.1%, 9.7%, 13.5% and 18.9%; P = .007). Multivariate regression analysis showed that hyperglycemia at admission (≥ 181 mg/dL) was a strong independent predictor of mortality during follow-up (hazard ratio = 1.74; 95% confidence interval, 1.07-2.8; P = .027). In the fourth quartile (≥ 181 mg/dL), the mortality is higher in patients with higher variations of glycemia (37.5% vs 8.5%; P < .001).
Hyperglycemia at admission is a predictor of all-cause mortality in our population. The mortality is higher in patients with higher glycemic variations. More studies are needed to confirm these data.
Full English text available from: www.revespcardiol.org/en
Effect of an optimized treatment with insulin on platelet reactivity after discharge in patients with an acute coronary syndrome and hyperglycemia
2014, Revista Espanola de Cardiologia
El control intensivo con insulina de la glucemia de pacientes con un síndrome coronario agudo reduce la reactividad plaquetaria durante la fase hospitalaria en comparación con un tratamiento convencional. Sin embargo, se desconoce el efecto en la reactividad plaquetaria con un control estricto de la glucemia a largo plazo.
Ensayo prospectivo y aleatorizado que evaluó el efecto de un tratamiento optimizado para el control de la glucemia (objetivo, 80-120 mg/dl) con insulina comparado con un tratamiento convencional (objetivo, < 180 mg/dl) en la reactividad plaquetaria al alta hospitalaria de pacientes con un síndrome coronario agudo e hiperglucemia. El objetivo primario es la valoración de la agregación plaquetaria tras estímulo con adenosina difosfato 20 μM a los 12 meses de seguimiento.
Se incluyó a 104 pacientes (53 al tratamiento optimizado y 51 al convencional). No se encontraron diferencias en las características basales de ambos grupos, incluida la función plaquetaria. A los 12 meses de seguimiento, las cifras de glucemia eran significativamente menores en el grupo de tratamiento optimizado (104 frente a 119 mg/dl; p < 0,001). Sin embargo, la agregación plaquetaria tras estímulo con adenosina difosfato 20 μM no mostró diferencias significativas entre los grupos (tratamiento optimizado frente a convencional, 54,2 ± 14,3% frente a 55,1 ± 18,3%; p = 0,81). Tampoco se objetivaron diferencias significativas con los otros tests de función plaquetaria evaluados.
El control optimizado de la glucemia con insulina a largo plazo en pacientes que han sufrido un síndrome coronario agudo no reduce la reactividad plaquetaria en comparación con un tratamiento convencional.
Intensive glucose control with insulin in patients with an acute coronary syndrome reduces platelet reactivity during hospitalization, compared to conventional control. However, the effect of strict, long-term glucose control on platelet reactivity in these patients remains uncertain.
This is a prospective, randomized trial evaluating the effects of optimized glucose control (target glucose, 80-120 mg/dL) with insulin, compared with conventional control (target glucose, <180 mg/dL), on platelet reactivity after hospital discharge in patients with an acute coronary syndrome and hyperglycemia. The primary endpoint was assessment of platelet aggregation after stimulation with adenosine diphosphate 20 μM at 12-month follow-up.
One hundred four patients were randomized to optimized management (n=53) or conventional management (n=51). There were no differences between groups in baseline characteristics or platelet function. After 12 months of follow-up, blood glucose levels were significantly lower in the optimized treatment group (104 vs 119 mg/dL; P<.001). However, platelet aggregation following adenosine diphosphate 20 μM stimulation showed no differences between the groups (54.2% [14.3%] vs 55.1% [18.3%] respectively; P=.81). There were no significant differences for other platelet function tests.
Long-term optimized glucose control with insulin in patients with an acute coronary syndrome did not result in a reduction in platelet reactivity compared to conventional control.
Full English text available from: www.revespcardiol.org/en
Predictive value of first fasting plasma glucose compared with admission plasma glucose for undiagnosed diabetes in a stable cardiology population
2012, Clinical Biochemistry
Citation Excerpt :
However, APG provides less predictive value than the first FGP dose. And other authors have also found that the first FPG level was a better predictor of an adverse outcome during hospitalization in ACS patients than the APG level [25]. The model including CAD, hypertension, high levels of hs-CRP and the first FGP ≥ 5.6 mmol/l (100 mg/dL) may be the best tool to identify DM patients without previously known diabetes.
The study compared the predictive value of admission plasma glucose (APG) and first fasting plasma glucose (FPG) in stratifying patients meriting an oral glucose tolerance test (OGTT).
Characteristics of APG, FPG and OGTT 2-hour glucose as well as other blood measurements, physical examinations and medical information were assessed in 994 patients without known diabetes.
The prevalences of diabetes and impaired glucose tolerance were 24.6% and 37.9%, according to an OGTT, respectively. The first FPG demonstrated stronger predictive value in diagnosing diabetes than APG did both in overall and in patients with less clinical value. Compared to the first FPG, APG provided less value to coronary artery disease, hypertension and high-sensitivity C-reactive protein for diabetes screening.
The first FPG exerted more predictive value than APG did and was still a preferable reference prior to APG in stratifying patients for undiagnosed diabetes by an OGTT.
Performance of glycated hemoglobin and a risk model for detection of unknown diabetes in coronary patients
2011, Revista Espanola de Cardiologia
Clásicamente, la sobrecarga oral de glucosa ha diagnosticado la diabetes desconocida. Recientemente, la American Diabetes Association ha aceptado un valor de glucohemoglobina ≥ 6,5% como criterio de diabetes desconocida. Pretendemos conocer la rentabilidad que tiene la glucohemoglobina para la detección de diabetes desconocida y validar un modelo que permita ajustar la realización de la sobrecarga oral de glucosa en enfermos coronarios.
Se estudia el perfil glucémico de 338 enfermos coronarios sin diabetes conocida. Se usan los criterios de la American Diabetes Association de 2010 y, mediante regresión logística, se construye un modelo predictor de diabetes desconocida. Se valida el modelo en otra cohorte.
Se diagnosticó diabetes desconocida a 26 enfermos mediante glucohemoglobina y/o glucemia basal. Los demás presentaban, tras realizar sobrecarga oral de glucosa: diabetes desconocida, 53 (17%); prediabetes, 144 (46,2%), y normoglucemia, 115 (36,8%). Método diagnóstico de diabetes desconocida: glucemia basal, 25,3%; glucohemoglobina, 7,6%, y sobrecarga oral de glucosa, 67,1%. Un modelo que incluye glucemia basal, glucohemoglobina, fracción de eyección de ventrículo izquierdo, edad y enfermedad vascular no coronaria resultó eficaz como predictor de diabetes desconocida tras sobrecarga oral de glucos: área bajo la curva ROC, 0,8 (intervalo de confianza del 95%, 0,74-0,87). Realizando sobrecarga oral de glucosa sólo a la población con puntuación del modelo > 6 (el 31% del total), podemos localizar al 83% de los casos de diabetes desconocida reales (sensibilidad, 75%; especificidad, 73%; valor predictivo positivo, 40%; valor predictivo negativo, 93%). El modelo se validó correctamente en otra cohorte de 115 pacientes (área bajo la curva ROC, 0,84 [intervalo de confianza del 95%, 0,74-0,95]).
La glucohemoglobina diagnostica aisladamente pocos casos de diabetes desconocida. Sin embargo, su incorporación a un modelo de riesgo permite optimizar la indicación de la sobrecarga oral de glucosa, con un aprovechamiento óptimo.
Traditionally, the oral glucose tolerance test has been useful to diagnose unknown diabetes. Recently, the American Diabetes Association committee has accepted glycated hemoglobin ≥6.5% as a criterion for unknown diabetes. The aim was to determine the benefit of glycated hemoglobin for diagnosing unknown diabetes and also create a predictive model that adjusts the indication for oral glucose tolerance test in coronary patients.
We examined the glycemic profile of 338 coronary patients without previous diagnosis of diabetes, applying 2010 American Diabetes Association criteria. A unknown diabetes risk predictive model was developed using logistic regression analysis, and then validated in another cohort.
Using the glycated hemoglobin criteria and/or fasting plasma glucose, unknown diabetes was diagnosed in 26 patients. The remaining patients were classified according to oral glucose tolerance test as follows: unknown diabetes 53 (17%), prediabetes 144 (46.2%), and normoglycemic 115 (36.8%). The diagnostic method for unknown diabetes was fasting plasma glucose in 25.3%, glycated hemoglobin in 7.6%, and oral glucose tolerance test in 67.1%. A risk model including fasting plasma glucose, glycated hemoglobin, left ventricular ejection fraction, age, and noncoronary vascular disease was shown to effectively predict unknown diabetes after oral glucose tolerance test: area under the ROC curve 0.8 (95% confidence interval: 0.74-0.87). When the oral glucose tolerance test is restricted to patients with a risk score >6 (31% of our sample) we properly identify 83% of unknown diabetes cases (sensitivity: 75%, specificity: 73%, positive predictive value: 40%, negative predictive value: 93%). The model was adequately validated in another cohort of 115 patients (area under the ROC curve 0.84 [95% confidence interval: 0.74-0.95]).
In coronary patients, glycated hemoglobin alone failed to detect many cases of unknown diabetes. However, its inclusion in a risk prediction model leads to optimizing the usefulness of oral glucose tolerance test.
Full English text available from: www.revespcardiol.org
Prognostic implications of stress hyperglycemia in acute st elevation myocardial infarction. Prospective observational study
2011, Revista Espanola de Cardiologia
La hiperglucemia al ingreso se asocia a mal pronóstico en pacientes con infarto agudo de miocardio. El objetivo es evaluar la asociación independiente entre la hiperglucemia de estrés y la mortalidad hospitalaria en pacientes con infarto agudo de miocardio con elevación del ST (IAMCEST).
Analizamos a 834 pacientes ingresados de forma consecutiva por IAMCEST en la Unidad Coronaria. La asociación entre la glucemia al ingreso y la mortalidad hospitalaria se evaluó mediante regresión de Cox. La capacidad discriminatoria del modelo multivariable se evaluó mediante el estadístico C de Harrell.
La mortalidad fue del 10,7% (89/834 pacientes). Mediante las curvas ROC se determinó como punto de corte óptimo para la mortalidad una glucemia ≥ 140 mg/dl. La incidencia de arritmias fue más frecuente en pacientes con glucemias ≥ 140 mg/dl, tanto para las arritmias ventriculares malignas (el 28 frente al 18%; p = 0,001) como para los trastornos de conducción intraventricular (el 5 frente al 2%; p = 0,005) y auriculoventricular (el 9 frente al 5%; p = 0,05), al igual que ocurrió con la incidencia de muerte intrahospitalaria (el 15 frente al 5%; p < 0,001). En el análisis multivariable, los pacientes con glucemia ≥ 140 mg/dl presentaron el doble de mortalidad intrahospitalaria (intervalo de confianza del 95%, 1,2-3,5; p = 0,008). El valor pronóstico de la glucemia (como variable continua y como variable dicotomizada) no varió significativamente según hubiera diabetes o no (para la interacción, p = 0,487 y p = 0,653 respectivamente).
La hiperglucemia de estrés al ingreso es un predictor de mortalidad y arritmias en pacientes con IAMCEST y se podría usar en la estratificación de riesgo de estos pacientes.
In patients with acute myocardial infarction, elevation of plasma glucose levels is associated with worse outcomes. The aim of this study was to evaluate the association between stress hyperglycemia and in-hospital mortality in patients with acute myocardial infarction with ST-segment elevation (STEMI).
We analyzed 834 consecutive patients admitted for STEMI to the Coronary Care Unit of our center. Association between admission glucose and mortality was assessed with Cox regression analysis. Discriminative accuracy of the multivariate model was assessed by Harrell's C statistic.
Eighty-nine (10.7%) patients died during hospitalization. Optimal threshold glycemia level of 140 mg/dl on admission to predict mortality was obtained by ROC curves. Those who presented glucose ≥140 mg/dl showed higher rates of malignant ventricular tachyarrhythmias (28% vs. 18%, P = .001), complicative bundle branch block (5% vs. 2%, P = .005), new atrioventricular block (9% vs. 5%, P = .05) and in-hospital mortality (15% vs. 5%, P < .001). Multivariate analysis showed that those with glycemia ≥140 mg/dl exhibited a 2-fold increase of in-hospital mortality risk (95% CI: 1.2-3.5, P = .008) irrespective of diabetes mellitus status (P-value for interaction = 0.487 and 0.653, respectively).
Stress hyperglycemia on admission is a predictor of mortality and arrhythmias in patients with STEMI and could be used in the stratification of risk in these patients.
Full English text available from: www.revespcardiol.org
Admission and fasting plasma glucose for estimating risk of death of diabetic and nondiabetic patients with acute coronary syndrome: nonlinearity of hazard ratios and time-dependent comparison
2009, American Heart Journal
Citation Excerpt :
Secondly, a given hyperglycemic blood glucose level implies a greater surge in blood glucose in a truly nondiabetic patient than in a diabetic patient, which suggests a higher degree of stress and hence greater risk of death.9 Relatively few previous studies have compared the prognostic utility of admission glucose with that of the first postadmission fasting glucose measurement or some kind of average fasting glucose measure.7,10,21 Most of those that have, have found that fasting glucose is the better predictor of inhospital or 30-day mortality, at least among patients without previously diagnosed diabetes, and this finding appears to be independent of the therapy received in hospital.7,10,21
In patients with acute coronary syndrome (ACS), increased plasma glucose levels are associated with worse outcome. Our aim is to ascertain the values of admission and fasting glucose for prediction of death among patients with ACS; and to compare their predictive capacities.
The relationships of mortality to plasma glucose levels among 811 consecutive patients hospitalized with ACS were estimated using spline Cox models. Blood samples were obtained upon admission and after overnight fast. The predictive capacities of fasting and admission glucose were compared using time-dependent receiver operating characteristic curves.
Fasting and admission glucose levels were higher among the 151 patients who died (18.6%) than among survivors (P < .001). Among the 558 patients with no history of diabetes (68.8%) there was a J-shaped dependence of the all-time mortality hazard ratio on fasting glucose that persisted when adjusted for covariates: hazard was lowest at 110 mg/dL (6.1 mmol/L), and significantly greater at levels <90 mg/dL (5.0 mmol/L) or >117 mg/dL (6.5 mmol/L). Likewise among non-diabetic patients, the predictive capacities of admission and fasting glucose were similar for forecast times of up to about 1 year, but for later times the area under the receiver operating characteristic curve was larger for fasting glucose than admission glucose (P < .05). Neither admission nor fasting glucose levels discriminated among diabetic patients in regard to risk of death.
Both admission and fasting glucose may be used for triage of nondiabetic ACS patients; fasting glucose may additionally be useful for long-term management, for which the relationship with the all-time mortality hazard ratio is J-shaped.

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Artículo originalValor pronóstico de la primera glucemia en ayunas en comparación con la glucemia al ingreso en pacientes con síndrome coronario agudoPrognostic Value of First Fasting Glucose Measurement Compared With Admission Glucose Level in Patients With Acute Coronary Syndrome☆

Introducción y objetivos

Métodos

Resultados

Conclusiones

Introduction and objectives

Methods

Results

Conclusions

Section snippets

INTRODUCCIÓN

Población del estudio

RESULTADOS

DISCUSIÓN

CONCLUSIONES

Lancet

Am Heart J

Rev Esp Cardiol

Int J Cardiol

Am Heart J

Lancet

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Presentation, management and outcomes of diabetic patients compared to non-diabetic patients admitted for acute coronary syndromes

Heart

Global prevalence of diabetes. Estimates for the year 2000 and projections for 2030

Diabetes Care

Blood glucose and coronary artery disease in nondiabetic patients

Diabetes Care

The association between hyperglycaemia on admission and 180-day mortality in acute myocardial infarction patients with and without diabetes

Diabet Med

Admission blood glucose level as risk indicator of death after myocardial infarction in patients with and without diabetes mellitus

Arch Intern Med

Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes

Circulation

Artículo original
Valor pronóstico de la primera glucemia en ayunas en comparación con la glucemia al ingreso en pacientes con síndrome coronario agudoPrognostic Value of First Fasting Glucose Measurement Compared With Admission Glucose Level in Patients With Acute Coronary Syndrome☆