QJM Advance Access originally published online on February 27, 2006
QJM 2006 99(4):237-243; doi:10.1093/qjmed/hcl028
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Prognostic value of admission glucose and glycosylated haemoglobin levels in acute coronary syndromes
From the Departments of 1Cardiology, 2Internal Medicine and 3Laboratory Medicine, Isala Klinieken, Zwolle, and 4Department of Cardiology, Thoraxcenter, University Medical Centre, Groningen, The Netherlands
Address correspondence to Dr J.P. Ottervanger, Department of Cardiology, Isala Klinieken, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands. email: v.r.c.derks{at}isala.nl
Received 10 August 2005 and in revised form 16 January 2006
Background: Admission hyperglycaemia is associated with poorer prognosis in patients with an acute coronary syndrome (ACS). Whether hyperglycaemia is more important than prior long-term glucose metabolism, is unknown.
Aim: To investigate the prognostic value of admission glucose and HbA1c levels in patients with ACS.
Methods: We measured glucose and HbA1c at admission in 521 consecutive patients with suspected ACS. Glucose was categorized as <7.8 (n = 305), 7.8–11.0 (n = 138) or 
11.1 mmol/l (n = 78); HbA1c as <6.2% (n = 420) or 6.2% (n = 101). Mean follow-up was 1.6 ± 0.5 years.
Results: The diagnosis of ACS was confirmed in 332 patients (64%), leaving 189 (36%) with atypical chest pain. In ACS patients, mortality by glucose category (<7.8, 7.8–11.0 or 11.1 mmol) was 9%, 8% and 25%, respectively (p = 0.001); mortality by HbA1c category (<6.2% vs. 6.2%) was 10% vs. 17%, respectively (p = 0.14). On multivariate analysis, glucose category was significantly associated with mortality (HR 3.0, 95%CI 1.1–8.3), but HbA1c category was not (HR 1.5, 95%CI 0.6–4.2).
Discussion: Elevated admission glucose appears more important than prior long-term abnormal glucose metabolism in predicting mortality in patients with suspected ACS.
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