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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.

Publication ,  Journal Article
Sinnaeve, PR; Steg, PG; Fox, KAA; Van de Werf, F; Montalescot, G; Granger, CB; Knobel, E; Anderson, FA; Dabbous, OH; Avezum, A; GRACE Investigators,
Published in: Arch Intern Med
February 23, 2009

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.

Duke Scholars

Published In

Arch Intern Med

DOI

EISSN

1538-3679

Publication Date

February 23, 2009

Volume

169

Issue

4

Start / End Page

402 / 409

Location

United States

Related Subject Headings

  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Registries
  • Odds Ratio
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Sinnaeve, P. R., Steg, P. G., Fox, K. A. A., Van de Werf, F., Montalescot, G., Granger, C. B., … GRACE Investigators, . (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. Arch Intern Med, 169(4), 402–409. https://doi.org/10.1001/archinternmed.2008.572
Sinnaeve, Peter R., P Gabriel Steg, Keith A. A. Fox, Frans Van de Werf, Gilles Montalescot, Christopher B. Granger, Elias Knobel, 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 169, no. 4 (February 23, 2009): 402–9. https://doi.org/10.1001/archinternmed.2008.572.
Sinnaeve PR, Steg PG, Fox KAA, Van de Werf F, Montalescot G, Granger CB, Knobel E, Anderson FA, Dabbous OH, Avezum A, GRACE Investigators. 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):402–409.

Published In

Arch Intern Med

DOI

EISSN

1538-3679

Publication Date

February 23, 2009

Volume

169

Issue

4

Start / End Page

402 / 409

Location

United States

Related Subject Headings

  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Registries
  • Odds Ratio
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans