Original paper
Is diabetes combined with admission hyperglycaemia better than diabetes alone in risk stratification in patients with acute coronary syndromes?

Aim: To assess whether combination of admission hyperglycaemia and diabetes mellitus (DM) has better prognostic value than DM alone in patients with acute coronary syndrome (ACS) treated with primary percutaneous coronary intervention (PCI).

Material and methods: Patients were stratified based on the history of DM and admission blood glucose concentration. Hyperglycaemia was defined as an admission plasma glucose level of > 140 mg/dl. Total mortality was evaluated during 591 ±187 days of follow-up.

Results: A total of 704 patients with ACS were included in the analysis. The mean age was 63 ±11 years. During follow-up, 8% (n = 56) of the patients died. Mortality rate in normoglycaemic DM patients in relation to normoglycaemic non-DM patients was similar (9% vs. 7%, p = 0.4). In the multivariable model of Cox regression analysis DM was not an independent predictor of mortality (HR = 1.36, 95% CI 0.66-2.80, p = 0.40). Increased mortality was observed in DM hyperglycaemic patients in relation to normoglycaemic non-DM patients (21% vs. 7%, p = 0.0005). In the model of Cox regression analysis the adjusted relative risk of death in the patients with DM and hyperglycaemia was two times higher than in the non-diabetic normoglycaemic patients (HR = 2.28, 95% CI 1.15-4.52, p = 0.02). For the multivariable modelling, DM with hyperglycaemia remained an independent predictor of mortality (HR = 2.40, 95% CI 1.20-4.82, p = 0.01).

Conclusions: Admission hyperglycaemia together with history of diabetes is a strong predictor of mortality in ACS patients treated with PCI, while diabetes alone is not. Elevated glucose levels can be integrated along with diabetes into the risk stratification in ACS patients.