The Characteristics Of Blood Glucose During Hospitalization In Patient With Acute Coronary Syndrome And The Recent Prognosis Study

The characteristics of blood glucose during hospitalization in patient with acute coronary syndrome and the recent prognosis studyIncreased cardiovascular risk in diabetes mellitus has been well-documented.Hyperglycemia could predict mortality from cardiovascular diseases in patients with type 2 diabetes.U.K. Prospective Diabetes Study(UKPDS)conclusively showed that mean HbA1c predicts myocardial infarction in type 2 diabetes.However,when HbA1c was reduced by intensive treatment,a significant decrease at microvascular complications was found,but no in diabetes-related mortality or myocardial infarction was observed.The Diabetes Control and Complications Trial(DCCT)showed that the level of HbA1c in diabetic patients has positive relations with microvascularcomplications.Furthermore it also showed that the conventional therapy group had a increased morbility of diabetic retinopathy compared with the intensive therapy group,which suggested that the variation of blood glucose might be another factor affecting prognoses except the mean blood glucose.Verona Diabetes Study reported that fasting plasma glucose(FPG) variability,as assessed by the coefficient of variation(CV)of FPG over a period of three years,was an independent predictor of all-cause and cardiovascular mortality in patients with type 2 diabetes aged 75 years. But,when the CV of FPG was introduced in a multivariate survival analysis, mean FPG was not a significant predictor of mortality.Moritoki Egi' s study concluded that the SD of glucose concentration was a significant independent predictor of intensive care unit and hospital mortality. Decreasing the variability of blood glucose concentration might be an important aspect of glucose management.Some studies of patients with acute myocardial infarction have reported that hyperglycaemia at admission and the maximum blood glucose concentration duringhospitalization might be associated with a worse outcome.This study aimed to evaluate the association of blood glucose state with the outcome of patients with acute coronary syndrome(ACS). Effect of glucose variability on the recent prognosis of acute coronary syndromeObjective It is not known whether glycemic instability may confer a risk of mortality that is in addition to that predicted by the mean blood glucose(MBG)value alone.This study explored effects of mean blood glucose and glucose variability during hospitalization on short-outcomes of acute coronary syndrome with or without diabetes.Methods 1.The clinical data of 878 patients with acute coronary syndrome(ACS)were collected.All the 878 cases of ACS were grouped into tertiles of mean and CV of blood glucose during hospitalization to compare the incidence rate of recent poor prognosis among the subgroups 2.And then,ACS patients with and without diabetes were each grouped into tertile s of mean and CV of blood glucose during hospitalization to compare the incidence rate of recent poor prognosis among the subgroups。3.The mean blood glucose and glucose variability during hospitalization as well as sex,age,diabetes history,smoking,hypertension,hypertriglyceridemia and hypercholesterolemia were used as independent variables and mortality from all causes was used as end points in multivariate gradual regressive analysis.Other statistics were carried out by unpaired student' s t test,x~2 test.Statistical analyses were performed with statistical packages SPSS13.0.Results 1.Of the 878 cases of ACS,82 patients died during hospitalization.Having diabetes or cerebral apoplexy history,combining hypertension,hypertriglyceridemia and hypercholesterolemia significantly increased across tertils of both the mean and CV of random blood glucose during hospitalization.Proportion of woman and smoking was not significantly different in tertiles of the mean or the CV of random blood glucose during hospitalization.Deaths from all causes increased significantly across tertiles of both the mean and CV of random blood glucose during hospitalization.2.Of 878 cases of ACS,298 patients combined with diabetes history。When they were each grouped into tertile s of mean and CV of blood glucose duringhospitalization,there were positive correlations between CV of blood glucose and the death rate during hospitalization.3.In addition to the mortality could be predicted by the mean blood glucose,the CV of blood glucose was an independent predictor of total mortality Conclusions Glucose variability might be considered a useful additional parameter in the management of these patients,and hyperglycemia of ACS patients should be strictly controlled.Clinical characteristics of diabetic and nondiabetic patients with an acute coronary syndrome(ACS)and the revelance between glucose variability and the severity of coronary artery diseaseObjective To describe the clinical characteristics,management and outcomes of diabetic or nondiabetic patients with an acute coronary syndrome(ACS),and also to study the revelance between glucose variability and the severity of coronary artery disease.Methods To examine differences in these factors,878 cases of acute coronary syndrome(patients with ST-segment elevation acute myocardial infarction, non-ST-segment elevation acute myocardial infarction,and unstable angina)were enrolled.Results Approximately 1 in 4 patients presented with a history of diabetes.Patients with diabetes were older, more women,with a higher prevalence of comorbidities,and they were less likely to be treated with effective cardiac therapies than nondiabetic patients.Patients with diabetes who developed ACS were at increased risk for each hospital outcome including heart failure,cardiogenic shock, and death.Conclusions Glucose variability might be considered a useful additional parameter in the management of these patients.Relationship between glucose management and the recent prognosis of acute coronary syndromeObjective Several indices of glucose control(such as mean glucose concentration(GluAve),maximum blood glucose concentration during hospitalization(GluMax)and blood glucose concentration on admission (GluAdm)have been shown to be the predictors of critically ill patients' outcome.However,there is no information on the possible significance of variability in glucose concentration.This study explored whether the SD(a parameter commonly used to describe variability of measurement)of blood glucose concentration would independently predict mortality in ACS patients.Methods The data on characteristics,clinical features,and outcome of 878 patients with acute coronary syndrome(ACS)were collected,both mean and SD of blood glucose were calculated,other indices of blood glucose control such as GluMax and GluAdm were also collected.All the 878 cases of ACS were grouped into tertiles of mean and SD of blood glucose duringhospitalization,statistical assessment of the relation between these variables and hospital mortality were made.Results During hospitalization,82 patients died.There were positive correlations between SD of blood glucose and the death rate.In addition to the mortality could be predicted by the mean blood glucose,the SD of blood glucose was also an independent predictor of total mortality Conclusions Glucose variability might be considered a useful additional parameter in the management of these ACS patients and hyperglycemia and glucose stability of ACS patients should be strictly controlled.