Author + information
- Akihiro Kobayashi,
- Naoki Misumida and
- Yumiko Kanei
Elevated glucose level upon presentation has been reported to predict worse clinical outcomes in patients with acute coronary syndrome. However, the association between elevated glucose level and angiographic findings have not been fully elucidated.
We performed a retrospective analysis of consecutive patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI) who underwent coronary angiography within five days after presentation from January 2013 to June 2014. Patients with pre-admission diagnosis of diabetes were excluded. Glucose levels were measured upon admission. Blood glucose was defined elevated when blood glucose was greater than median glucose level in our cohort. Patients were categorized into elevated glucose group and control group. Obstructive coronary artery disease was defined as stenosis greater than or equal to 50% in the left main coronary artery and 70% in any other coronary artery. Baseline and angiographic characteristics were recorded. In addition, in-hospital major adverse cardiac events (MACE) including death, recurrent myocardial infarction, and target vessel revascularization were recorded and compared between the two groups.
After excluding 189 patients with pre-admission diagnosis of diabetes, 292 patients were included in the final analysis. The median glucose was 117 mg/dL (interquartile; 93, 121 mg/dL). Patients with elevated glucose had a higher rate of hypertension (77.5% vs. 61.8%, p=0.006) compared to patients in control group. Left ventricular ejection fraction was similar between the two groups (median [interquartile]; 60 [42-60] % vs. 60 [45-64] %, p=0.73). Patients with elevated glucose had a higher peak troponin I value (1.86 [0.18-8.59] ng/ml vs. 0.49 [0.08-4.51] ng/ml, p=0.046) than patients in control group. Patients with elevated glucose had a higher rate of left main and/or three-vessel disease (LM/3VD) (37.1% vs. 18.2%, p<0.001) compared to patients in control group. Multivariate analysis showed that elevated glucose was an independent predictor for LM/3VD (odds ratio 2.19; 95% confidence interval 1.19 to 4.02; p=0.011). No statistically significant difference was observed in in-hospital MACE between the two groups (1.1% vs. 1.0%, p=0.92).
In patients without pre-admission diagnosis of diabetes presenting with NSTEMI, elevated glucose level on presentation was an independent predictor for LM/3VD.