• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (13)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Cardiovascular System  • Prognosis/ Outcomes  • Cardiovascular Disease/ Myocardial Infarction  • Endocrine Diseases  • Diabetes Mellitus  • Alert me on articles by topic  Social Bookmarking   What's this?

The Global Registry of Acute Coronary Events

Peter R. Sinnaeve, MD, PhD; P. Gabriel Steg, MD; Keith A. A. Fox, MB, ChB, FRCP; Frans Van de Werf, MD, PhD; Gilles Montalescot, MD, PhD; Christopher B. Granger, MD; Elias Knobel, MD; Frederick A. Anderson, PhD; Omar H. Dabbous, PhD; Álvaro Avezum, MD, PhD; for the GRACE Investigators

Arch Intern Med. 2009;169(4):402-409.

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 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.

Author Affiliations: Department of Cardiology, University Hospitals Leuven Campus Gasthuisberg, Leuven, Belgium (Drs Sinnaeve and Van de Werf); Département de Cardiologie, Hôpital Bichat-Claude Bernard, Assistance Publique–Hôpitaux de Paris, Paris, France (Dr Steg); Cardiovascular Research, Division of Medical and Radiological Sciences, University of Edinburgh, Edinburgh, Scotland (Dr Fox); Institut de Cardiologie, Bureau 2-236, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris (Dr Montalescot); Duke University Medical Center, Durham, North Carolina (Dr Granger); Dante Pazzanese Institute of Cardiology, São Paulo, Brazil (Drs Knobel and Avezum); and University of Massachusetts Medical School, Worcester (Drs Anderson and Dabbous).

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Diagnosing diabetes on admission hyperglycaemia
Qureshi et al.
Heart 2012;98:3-4.
FULL TEXT  

Chapter 67 Hyperglycaemia and diabetes
Gielen et al.
The ESC Textbook of Acute and Intensive Cardiac Care 2010;1:med-9780199584314-chapter-med-9780199584314-chapter.
ABSTRACT | FULL TEXT  

Glycaemic control in acute coronary syndromes: prognostic value and therapeutic options
De Caterina et al.
Eur Heart J 2010;31:1557-1564.
ABSTRACT | FULL TEXT  

Intensive Insulin Therapy in Critically Ill Patients: NICE-SUGAR or Leuven Blood Glucose Target?
Van den Berghe et al.
J. Clin. Endocrinol. Metab. 2009;94:3163-3170.
ABSTRACT | FULL TEXT