Arbel Yaron, Shmueli Hezzy, Halkin Amir, Berliner Shlomo, Shapira Itzhak, Herz Itzhak, Havakuk Ofer, Shacham Yacov, Rabinovich Itay, Keren Gad, Finkelstein Ariel, Banai Shmuel
Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Clin Cardiol. 2014 Aug;37(8):479-84. doi: 10.1002/clc.22290. Epub 2014 May 2.
An increased serum glucose level in patients with acute coronary syndrome (ACS) is associated with adverse clinical outcome. This hyperglycemia has been attributed, at least in part, to acute stress reaction. Our objective was to determine whether hyperglycemia is a stress-related phenomenon or whether it represents a more sustained and possibly significant background dysglycemia.
Hyperglycemia in patients undergoing coronary angiography is related to background dysglycemia.
Blood samples were obtained at the time of cardiac catheterization. Patients with hemoglobin A1c >6.5% were excluded to avoid patients with chronic glucose levels above 135 mg/dL. A logistic regression model was created to assess the influence of different variables on hyperglycemia (glucose levels above 140 mg/dL). We also evaluated the effect of glucose levels above 140 mg/dL on major adverse cardiovascular events (MACEs) up to 36 months.
There were 2554 consecutive patients prospectively recruited. Serum glucose levels above 140 mg/dL was a strong predictor of MACE (hazard ratio: 2.2, 95% confidence interval [CI]: 1.3-3.6, P = 0.002). Both diabetes mellitus and ACS were associated with hyperglycemia (glucose levels above 140 mg/dL). Nevertheless, the incidence of hyperglycemia was doubled in diabetic patients (odds ratio [OR]: 9.4, 95% CI: 3.9-22.4, P < 0.001) compared with patients with ACS (OR: 4.6, 95% CI: 2.3-9.0, P < 0.001). Combining both conditions was associated with a high likelihood of elevated glucose levels (OR: 15.5, 95% CI: 7.4-32.9, P < 0.001).
Hyperglycemia in patients undergoing cardiac catheterization is a strong predictor of adverse outcome. It is mainly related to background dysglycemia and to a lesser extent to the acute stress accompanying ACS.
急性冠状动脉综合征（ACS）患者血清葡萄糖水平升高与不良临床结局相关。这种高血糖至少部分归因于急性应激反应。我们的目的是确定高血糖是一种与应激相关的现象，还是代表一种更持久且可能显著的背景性血糖异常。
接受冠状动脉造影的患者中的高血糖与背景性血糖异常有关。
在心脏导管插入术时采集血样。排除血红蛋白A1c>6.5%的患者，以避免慢性血糖水平高于135mg/dL的患者。创建逻辑回归模型以评估不同变量对高血糖（血糖水平高于140mg/dL）的影响。我们还评估了高达36个月时血糖水平高于140mg/dL对主要不良心血管事件（MACE）的影响。
前瞻性招募了2554例连续患者。血糖水平高于140mg/dL是MACE的有力预测指标（风险比：2.2，95%置信区间[CI]：1.3 - 3.6，P = 0.002）。糖尿病和ACS均与高血糖（血糖水平高于140mg/dL）相关。然而，与ACS患者相比，糖尿病患者高血糖的发生率增加了一倍（优势比[OR]：9.4，95%CI：3.9 - 22.4，P < 0.001）（ACS患者的OR：4.6，95%CI：2.3 - 9.0，P < 0.001）。两种情况同时存在与血糖水平升高的高可能性相关（OR：15.5，95%CI：7.4 - 32.9，P < 0.001）。
接受心脏导管插入术患者的高血糖是不良结局的有力预测指标。它主要与背景性血糖异常相关，在较小程度上与伴随ACS的急性应激相关。
