The online version of this article (doi:10.1186/1475-2840-11-47) contains supplementary material, which is available to authorized users.
Conflicts of Interest and Source of Funding: Authors declare no conflicts of interest. This study was partially supported by FAPESP and CNPq.
JYT cared out paper conception, writing, data collection and statistical analysis. RBR, LCR, SDA participated in data collection. JAFR participated in data analysis and review process. APM carried out paper conception, data collection and analysis. All authors read and approved the final manuscript.
Admission hyperglycaemia is associated with mortality in patients with acute coronary syndrome (ACS), but controversy exists whether hyperglycaemia uniformly affects both genders. We evaluated coronary risk factors, gender, hyperglycaemia and their effect on hospital mortality.
959 ACS patients (363 women and 596 men) were grouped based on glycaemia ≥ or < 200 mg/dL and gender: men with glucose < 200 mg/dL (menG-); women with glucose < 200 mg/dL (womenG-); men with glucose ≥ 200 mg/dL (menG+); and women with glucose ≥ 200 mg/dL (womenG+). A logistic regression analysis compared the relation between gender and glycaemia groups and death, adjusted for coronary risk factors and laboratory data.
menG- had lower mortality than menG + (OR = 0.172, IC95% 0.062-0.478), and womenG + (OR = 0.275, IC95% 0.090-0.841); womenG- mortality was lower than menG + (OR = 0.230, IC95% 0.074-0.717). No difference was found between menG + vs womenG + (p = 0.461), or womenG- vs womenG + (p = 0.110). Age (OR = 1.067, IC95% 1.031–1.104), EF (OR = 0.942, IC95% 0.915-0.968), and serum creatinine (OR = 1.329, IC95% 1.128-1.566) were other independent factors related to in-hospital death.
Death was greater in hyperglycemic men compared to lower blood glucose men and women groups, but there was no differences between women groups in respect to glycaemia after adjustment for coronary risk factors.
Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, Filippatos G, Fox K, Huber K, Kastrati A, Rosengren A, Steg PG, Tubaro M, Verheugt F, Weidinger F, Weis M: ESC Committee for Practice Guidelines (CPG). Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J. 2008, 29: 2909-2945. CrossRefPubMed
Ramos RB, Strunz CM, Avakian SD, Ramires JA, Mansur AP: B-type natriuretic peptide as a predictor of anterior wall location in patients with non-ST-elevation myocardial infarction. Clinics (São Paulo). 2011, 66: 437-441. CrossRef
Straumann E, Kurz DJ, Muntwyler J, Stettler I, Furrer M, Naegeli B, Frielingsdorf J, Schuiki E, Mury R, Bertel O, Spinas GA: Admission glucose concentrations independently predict early and late mortality in patients with acute myocardial infarction treated by primary or rescue percutaneous coronary intervention. Am Heart J. 2005, 150: 1000-1006. CrossRefPubMed
Beck JA, Meisinger C, Heier M, Kuch B, Hörmann A, Greschik C, Koenig W: Effect of blood glucose concentrations on admission in non-diabetic versus diabetic patients with first acute myocardial infarction on short- and long-term mortality (from the MONICA/KORA Augsburg Myocardial Infarction Registry). Am J Cardiol. 2009, 104: 1607-1612. CrossRefPubMed
Cid-Alvarez B, Gude F, Cadarso-Suarez C, Gonzalez-Babarro E, Rodriguez-Alvarez MX, Garcia-Acuna JM, Gonzalez-Juanatey JR: Admission and fasting plasma glucose for estimating risk of death of diabetic and nondiabetic patients with acute coronary syndrome: nonlinearity of hazard ratios and time-dependent comparison. Am Heart J. 2009, 158: 989-997. CrossRefPubMed
Hoebers LP, Damman P, Claessen BE, Vis MM, Baan J, van Straalen JP, Fischer J, Koch KT, Tijssen JG, de Winter RJ, Piek JJ, Henriques JP: Predictive value of plasma glucose level on admission for short and long term mortality in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Am J Cardiol. 2011
Jneid H, Fonarow GC, Cannon CP, Hernandez AF, Palacios IF, Maree AO, Wells Q, Bozkurt B, Labresh KA, Liang L, Hong Y, Newby LK, Fletcher G, Peterson E, Wexler L: Get With the Guidelines Steering Committee and Investigators. Sex differences in medical care and early death after acute myocardial infarction. Circulation. 2008, 118: 2803-2810. CrossRefPubMed
Champney KP, Frederick PD, Bueno H, Parashar S, Foody J, Merz CN, Canto JG, Lichtman JH, Vaccarino V: NRMI Investigators. The joint contribution of sex, age and type of myocardial infarction on hospital mortality following acute myocardial infarction. Heart. 2009, 95: 895-899. PubMedCentralCrossRefPubMed
Malmberg K, Norhammar A, Wedel H, Ryden L: Glycometabolic state at admission: important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction: long-term results from the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study. Circulation. 1999, 99: 2626-2632. CrossRefPubMed
Oswald GA, Smith CC, Betteridge DJ, Yudkin JS: Determinants and importance of stress hyperglycaemia in non-diabetic patients with myocardial infarction. Br Med J (Clin Res Ed). 1986, 293: 917-922. CrossRef
Marfella R, Verrazzo G, Acampora R, La Marca C, Giunta R, Lucarelli C, Paolisso G, Ceriello A, Giugliano D: Glutathione reverses systemic hemodynamic changes by acute hyperglycaemia in healthy subjects. Am J Physiol. 1995, 268: E1167-E1173. PubMed
Timmer JR, Ottervanger JP, de Boer MJ, Dambrink JH, Hoorntje JC, Gosselink AT, Suryapranata H, Zijlstra F, Hof AW Van 't: Zwolle Myocardial Infarction Study Group. Hyperglycaemia is an important predictor of impaired coronary flow before reperfusion therapy in ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2005, 45: 999-1002. CrossRefPubMed
Sinnaeve PR, Steg PG, Fox KA, Van de Werf F, Montalescot G, Granger CB, Knobel E, Anderson FA, Dabbous OH, Avezum A: GRACE Investigators. Association of elevated fasting glucose with increased short-term and 6-month mortality in ST-segment elevation and non-ST-segment elevation acute coronary syndromes: the Global Registry of Acute Coronary Events. Arch Intern Med. 2009, 169: 402-409. CrossRefPubMed
Takada JY, Ramos RB, Avakian SD, Santos SM, Ramires JAF, Mansur AP: BNP and Admission Glucose as In-Hospital Mortality Predictors in Non-ST Elevation Myocardial Infarction. Sci World J. 2012, 2012: 397915-Epub 2012 Jan 4 CrossRef
Valente S, Lazzeri C, Chiostri M, Giglioli C, Zucchini M, Grossi F, Gensini GF: Gender-related difference in ST-elevation myocardial infarction treated with primary angioplasty: a single-centre 6-year registry. Eur J Prev Cardiolog. 2012, 19: 233-40. Epub 2011 Mar 7 CrossRef
Mansur A, De P, Favarato D, Avakian SD, Ramires JA: Trends in ischemic heart disease and stroke death ratios in Brazilian women and men. Clinics (Sao Paulo). 2010, 65: 1143-1147. CrossRef
- In-hospital death in acute coronary syndrome was related to admission glucose in men but not in women
Julio Yoshio Takada
Rogério Bicudo Ramos
Larissa Cardoso Roza
Solange Desiree Avakian
José Antonio Franchini Ramires
Antonio de Pádua Mansur
- BioMed Central
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