Admission Plasma Glucose levels Within the Normal to Mildly Impaired Range and the Outcome of Patients with Acute Coronary Syndrome

Kirill Buturlin 1 Yoram Neuman 1 Meital Shlezinger 2 Ilan Goldenberg 2 Morris Mosseri 1 David Pereg 1
1Department of Cardiology, Meir Medical center, Kfar Saba, Israel
2Department of Cardiology, Sheba Medical Center, Tel hashomer, Israel

Background: Elevated admission plasma glucose (APG)  levels >140mg/dl are associated with adverse clinical outcomes in both diabetic and non-diabetic patients admitted with acute coronary syndromes (ACS).  We aimed to evaluate the association between APG levels<140mg/dl and all-cause mortality at 1 year in non-diabetic patients admitted with ACS.

Methods: The study population consisted of patients with ACS included in the Acute Coronary Syndromes Israeli biennial Surveys (ACSIS) during 2000-2013. Patients with a history of diabetes mellitus were excluded. The primary endpoint was all-cause mortality at 1 year.

Results: The 4,524 patients had a mean age of 61.7±13.5 years and were stratified into 4 quartiles according to APG (60-94, 95-105, 106-119, 120-140mg/dl). Patients with higher APG were older and included a higher percentage of smokers. In addition, the higher the  glucose so also did they have a poorer risk factor profile including a higher BMI,  total and LDL-cholesterol and triglyceride levels, and lower HDL-cholesterol levels. During the first year 5.2% of patients died. A comparison of 1-year mortality according to APG quartiles demonstrated a significant and progressive increase in mortality risk as APG rose (3.5%, 4.1%, 6.1%, 6.4%, p=0.001).

Conclusions: High APG levels even within the normal to mildly impaired range, are associated with increased 1-year all-cause mortality in non-diabetic patients admitted with ACS. Further investigation is needed for better understanding of this association before therapeutic recommendations can be made.









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