[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.