PROGNOSTIC VALUE OF HYPERGLYCAEMIA AND INFLAMMATION IN PATIENTS WITH ACUTE CORONARY SYNDROME

The prognostic significance of hyperglycaemia in patients with acute coronary syndrome (ACS) remains elusive. Different indices of impaired glucose metabolism, other than plasma glucose itself, are used to determine its prognostic role. The relationship between hyperglycaemia and inflammation in this acute clinical setting needs further clarification. Our aim is to investigate the role of different indices indicative for hyperglycemia (HI) and some inflammatory markers for assessing one- and five-year survival. We studied 255 patients with ACS, admitted to the Clinic of Cardiology, University Hospital "Alexandrovska", between February 2009 and December 2010. HI for acute (admission and fasting glycaemia), persistent (mean glucose, hyperglycaemic index - HGI, time average glucose - TAG) and chronic hyperglycaemia (estimated average glucose - eAG and glycated hemoglobin - HbA(1c)) were estimated by formulas. HbA(1c) was measured by NycoCardat admission and in six months. TNF-alpha and MMP-9 were assessed by ELISA method; CRP was measured by immunonephelometric method. All the indices for inflammation were assessed both at admission and six months later. A relation between HI, markers for inflammation, one- and five-year survival was studied. Our results show that HI - mean glycaemia (p = 0:041), HGI (p = 0:009), TAG (p = 0:007); inflammatory markers (TNF-alpha at admission (p = 0:039), MMP-9 at 6 months (p = 0:044)) were associated with one-year survival. None of the investigated markers alone showed an independent relation to five-year survival (p = 0:61). In conclusion HI (mean glycaemia, HGI, TAG) and inflammatory markers (TNF-alpha at admission, MMP-9 at 6th month) may be used as prognostic markers for one-year survival but not for long-term prognosis.