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QJM Advance Access published online on February 27, 2006
QJM, doi:10.1093/qjmed/hcl028
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© The Author 2006. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: Journals.permissions@oxfordjournals.org
Received August 10, 2005
Revised January 16, 2006

Original paper

Prognostic value of admission glucose and glycosylated haemoglobin levels in acute coronary syndromes

J.R. Timmer 1, J.P. Ottervanger 1 *, H.J.G. Bilo 2, J.H.E. Dambrink 1, K. Miedema 3, J.C.A. Hoorntje 1, and F. Zijlstra 4

1 From the Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands
2 From the Department of Internal Medicine, Isala Klinieken, Zwolle, The Netherlands
3 From the Department of Laboratory Medicine, Isala Klinieken, Zwolle, The Netherlands
4 From the Department of Cardiology, Thoraxcenter, University Medical Centre, Groningen, The Netherlands

* To whom correspondence should be addressed.
J.P. Ottervanger, E-mail: v.r.c.derks{at}isala.nl


  Abstract

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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