Kolman Louis, Hu Yu-Chen, Montgomery Daniel G, Gordon Kelly, Eagle Kim A, Jackson Elizabeth A
Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA.
Am J Cardiol. 2009 Aug 15;104(4):470-4. doi: 10.1016/j.amjcard.2009.04.006. Epub 2009 Jun 17.
Data are limited regarding the best prognostic glucose measure for patients admitted for an acute coronary event. We examined the admission fasting glucose levels among patients with acute coronary syndrome (ACS) from the University of Michigan ACS registry. The glucose levels were grouped into 3 categories (> or =70 to <100, 100 to <126, and > or =126 mg/dl). The primary outcome measures included mortality and a composite end point (stroke, recurrent infarction, and death) in hospital and at 6 months after the ACS event. Of the 1,525 patients (29% with diabetes) for whom glucose levels were available, a fasting glucose level of > or =100 mg/dl was associated with increased in-hospital mortality, after adjusting for the Global Registry of Acute Coronary Events risk score and gender. A fasting glucose level of > or =126 mg/dl in patients with no known history of diabetes was associated with in-hospital adverse events (odds ratio 3.37, 95% confidence interval 1.51 to 7.51). The fasting glucose level was associated with an increased risk of 6-month mortality among nondiabetics (odds ratio 3.03, 95% confidence interval 1.35 to 6.81 for patients with a glucose level of 100 to 125 mg/dl; and odds ratio 2.81, 95% confidence interval 1.07 to 7.36 for patients with a glucose level of > or =126 mg/dl) but not for diabetic patients. In conclusion, we observed a strong association between the admission fasting glucose level and mortality, particularly among nondiabetic patients. Whether improving the diagnosis and treatment of hyperglycemia would result in reductions in adverse events after ACS remains unclear.
关于急性冠脉事件入院患者最佳预后血糖指标的数据有限。我们研究了密歇根大学急性冠脉综合征（ACS）登记处中急性冠脉综合征患者的入院空腹血糖水平。血糖水平分为三类（≥70至<100、100至<126以及≥126mg/dl）。主要结局指标包括死亡率以及ACS事件后住院期间和6个月时的复合终点（中风、再发梗死和死亡）。在可获取血糖水平的1525例患者（29%患有糖尿病）中，在校正急性冠脉事件全球登记风险评分和性别后，空腹血糖水平≥100mg/dl与住院死亡率增加相关。在无糖尿病已知病史的患者中，空腹血糖水平≥126mg/dl与住院不良事件相关（比值比3.37，95%置信区间1.51至7.51）。空腹血糖水平与非糖尿病患者6个月死亡率增加风险相关（血糖水平为100至125mg/dl的患者，比值比3.03，95%置信区间1.35至6.81；血糖水平≥126mg/dl的患者，比值比2.81，95%置信区间1.07至7.36），但与糖尿病患者无关。总之，我们观察到入院空腹血糖水平与死亡率之间存在密切关联，尤其是在非糖尿病患者中。改善高血糖的诊断和治疗是否会降低ACS后的不良事件尚不清楚。
