Hyperglycaemia as bad prognostic factor in acute coronary syndrome

Objective: Hyperglycemia is a frequent observation in the acute coronary syndrome. We analyzed the relationship between hyperglycemia on admission and patients with acute coronary syndrome. Material and methods: Prospective study of 455 patients with acute coronary syndrome with and without elevation of ST segment with high risk according to ACA/AHA criteria. We divided the sample according to the median glycemia on admission into <139 mg/dl and >= 139 mg/dl. We studied the analytic, electrocardiography, echocardiography and epidemiologic variables. Using the Cox Proportional Hazard Model, we analyzed their relationship with the mortality as principal variable during a six-month period after the acute coronary syndrome. Results: Mean age was 64.3 +/- 12.7 years, 80.4% were male and 21.8% had been diagnosed with diabetes. Mean glycemia on admission was 163.3 +/- 71.8 mg/dl. Forty-seven patients died (10.3%), Mean glycemia of those who had died was 189.8 +/- 78.8 mg/dl compared to 160.3 +/- 70.4 mg/dl in the survival group (P=0.003). Patients with hyperglycemia on admission >= 139 mg/dl had higher mortality, hazard ratio (HR)=2.98 (confidence interval [CI 95%]: 1.06-8.4; P=0.039). Elderly patients, being a male, having ventricular dysfunction and initial decrease of blood pressure also showed an independent relationship with mortality. Conclusions: Hyperglycemia on admission >= 139 mg/dl in acute coronary syndrome patients is associated with a higher risk of death in the following six months, independently of diabetes or other risk factors known. (C) 2010 Elsevier Espana, S.L. All rights reserved.