1 Department of Cardiology, Meir Medical Center, Kfar Saba, Israel.
2 Cardiology Department, Assaf-Harofeh Medical Center, Zerifin, Israel.
Eur Heart J Acute Cardiovasc Care. 2017 Dec;6(8):738-743. doi: 10.1177/2048872616641900. Epub 2016 Apr 1.
Elevated admission plasma glucose levels >140 mg/dl are associated with adverse clinical outcomes in both diabetic and non-diabetic patients admitted with acute coronary syndrome (ACS). We aimed to evaluate the association between admission plasma glucose levels <140 mg/dl and the outcome of non-diabetic patients admitted with acute coronary syndrome.
The study population consisted of patients with acute coronary syndrome included in the Acute Coronary Syndrome Israeli Survey during 2000-2013. Diabetic patients were excluded. The primary endpoint was all-cause mortality at one year.
The 452 0 patients had a mean age of 61.7±13.5 years and were stratified into four quartiles according to admission plasma glucose (60-94, 95-105, 106-119, 120-140 mg/dl). Patients with higher admission plasma glucose were older and included a higher percentage of smokers. In addition, the higher the glucose so also did they have a poorer risk factor profile including a higher body mass index, total and low-density lipoprotein cholesterol and triglyceride levels, and lower high-density lipoprotein cholesterol levels. During the first year 5.2% of patients died. A comparison of one-year mortality according to admission plasma glucose quartiles demonstrated a significant and progressive increase in mortality risk as admission plasma glucose rose (3.5%, 4.1%, 6.1%, 6.4%, respectively, p=0.001). However, this association lost its clinical significance following a multivariate analysis ( p=0.08).
High admission plasma glucose levels within the normal to mildly impaired range are associated with increased one-year mortality in non-diabetic acute coronary syndrome patients. However, the higher glucose level is probably not the cause for the adverse outcome but rather a marker for high risk. Our findings support the definition of 140 mg/dl as the cutoff for clinically acceptable admission glucose levels in patients with acute coronary syndrome.
在患有急性冠状动脉综合征（ACS）的糖尿病和非糖尿病患者中，入院时血浆葡萄糖水平升高>140mg/dl 与不良临床结局相关。我们旨在评估入院时血浆葡萄糖水平<140mg/dl 与非糖尿病急性冠状动脉综合征患者结局之间的关系。
研究人群包括 2000 年至 2013 年期间纳入急性冠状动脉综合征以色列调查的急性冠状动脉综合征患者。排除糖尿病患者。主要终点是一年时的全因死亡率。
4520 例患者的平均年龄为 61.7±13.5 岁，并根据入院时的血浆葡萄糖水平（60-94、95-105、106-119、120-140mg/dl）分为四个四分位数。入院时血浆葡萄糖较高的患者年龄较大，且吸烟者比例较高。此外，血糖越高，其危险因素谱也越差，包括更高的体重指数、总胆固醇和低密度脂蛋白胆固醇及三酰甘油水平，以及更低的高密度脂蛋白胆固醇水平。在第一年中，有 5.2%的患者死亡。根据入院时的血浆葡萄糖四分位数比较一年死亡率，发现随着入院时血浆葡萄糖的升高，死亡率风险显著且逐渐增加（分别为 3.5%、4.1%、6.1%、6.4%，p=0.001）。然而，经过多变量分析后，这种关联失去了临床意义（p=0.08）。
在非糖尿病急性冠状动脉综合征患者中，正常至轻度受损范围内的高入院时血浆葡萄糖水平与一年死亡率增加相关。然而，较高的血糖水平可能不是不良结局的原因，而是高风险的标志物。我们的研究结果支持将 140mg/dl 定义为急性冠状动脉综合征患者可接受的入院血糖水平的切点。
