Journal
EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE
Volume 9, Issue 6, Pages 589-598Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1177/2048872618777819
Keywords
Acute coronary syndrome; diabetes; hyperglycaemia
Categories
Funding
- Swiss National Science Foundation [SPUM 33CM30-124112, SPUM 33CM30-140336, 32473B-163271, SNSF 320030-150025]
- Geneva University Hospitals
- Swiss Heart Foundation
- de Reuter Foundation
- Gerbex-Bourget Foundation
- Gustave-Prevot and Schmidheiny Foundation
- Roche Diagnostics
- Eli Lilly
- AstraZeneca
- Medtronic
- Merck Sharpe and Dome
- SanofiAventis
- St Jude Medical
- Zurich Heart House Foundation for Cardiovascular Research, Zurich, Switzerland
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Background: Controversy remains regarding the prevalence of hyperglycaemia in non-diabetic patients hospitalised with acute coronary syndrome and its prognostic value for long-term outcomes. Methods and results: We evaluated the prevalence of hyperglycaemia (defined as fasting glycaemia > 10 mmol/l) among patients with no known diabetes at the time of enrolment in the prospective Special Program University Medicine-Acute Coronary Syndromes cohort, as well as its impact on all-cause death, myocardial infarction, stroke and incidence of diabetes at one year. Among 3858 acute coronary syndrome patients enrolled between December 2009-December 2014, 709 (18.4%) had known diabetes, while 112 (3.6%) of non-diabetic patients had hyperglycaemia at admission. Compared with non-hyperglycaemic patients, hyperglycaemic individuals were more likely to present with ST-elevation myocardial infarction and acute heart failure. At discharge, hyperglycaemic patients were more frequently treated with glucose-lowering agents (8.9% vs 0.66%, p<0.001). At one-year, adjudicated all-cause death was significantly higher in non-diabetic patients presenting with hyperglycaemia compared with patients with no hyperglycaemia (5.4% vs 2.2%, p=0.041) and hyperglycaemia was a significant predictor of one-year mortality (adjusted hazard ratio 2.39, 95% confidence interval 1.03-5.56). Among patients with hyperglycaemia, 9.8% had developed diabetes at one-year, while the corresponding proportion among patients without hyperglycaemia was 1.8% (p<0.001). In multivariate analysis, hyperglycaemia at presentation predicted the onset of treated diabetes at one-year (odds ratio 4.15, 95% confidence interval 1.59-10.86; p=0.004). Conclusion: Among non-diabetic patients hospitalised with acute coronary syndrome, a fasting hyperglycaemia of > 10 mmol/l predicted one-year mortality and was associated with a four-fold increased risk of developing diabetes at one year.
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