The magnitude of the variation in glycemia: a new parameter for risk assessment in acute coronary syndrome?

Abstract

INTRODUCTION AND OBJECTIVES: The aim was to evaluate the relationship between the magnitude of the variation in the level of glycemia during hospitalization and in-hospital and long-term mortality and postdischarge endpoints in two groups of patients with acute coronary syndrome: those with and those without a previous diagnosis of diabetes. METHODS: The study included 1210 patients admitted for acute coronary syndrome between May 2004 and July 2007. The study population was divided in two subgroups: patients with a previous diagnosis of diabetes (n=386) and nondiabetics (n=824). Each subgroup was further divided into four smaller groups according to the quartile of glycemia variation: diabetics (Q1: or=164 mg/dl) and nondiabetics (Q1: or=60 mg/dl). Patients were followed up for an average of 18 months after the occurrence of the acute coronary syndrome. RESULTS: In diabetic patients, there was no relationship between the magnitude of the glycemia variation and in-hospital or postdischarge endpoints. In nondiabetics, no significant difference was observed in in-hospital mortality or morbidity, but statistically significant clinical differences were found during follow-up. Multivariate regression analysis showed that Q4 versus Q1, age >or=70 years, and previous antiplatelet or angiotensin-converting enzyme inhibitor therapy were independent predictors of postdischarge endpoints in the nondiabetic group. CONCLUSIONS: In nondiabetic acute coronary syndrome patients, the magnitude of the variation in glycemia observed during hospitalization was a strong independent predictor of postdischarge clinical endpoints