Glucose levels compared with diabetes history in the risk assessment of patients with acute myocardial infarction
Background Both a history of diabetes mellitus and elevated inhospital glucose levels predict death after acute myocardial infarction (AMI). However, only diabetes history (and not glucose levels) is routinely considered in AMI risk assessment. Methods We conducted a post hoc analysis of 2 randomize...
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| Veröffentlicht in: | The American heart journal 2009-04, Vol.157 (4), p.763-770 |
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| creator | Goyal, Abhinav, MD, MHS Mehta, Shamir R., MD, MSc Gerstein, Hertzel C., MD, MSc Díaz, Rafael, MD Afzal, Rizwan, MSc Xavier, Denis, MD Zhu, Jun, MD Pais, Prem, MD, MSc Lisheng, Liu, MD Kazmi, Khawar A., MD Zubaid, Mohammad, MD Piegas, Leopoldo S., MD, PhD Widimsky, Petr, MD, DrSC Budaj, Andrzej, MD, PhD Avezum, Alvaro, MD, PhD Yusuf, Salim, MBBS, DPhil |
| description | Background Both a history of diabetes mellitus and elevated inhospital glucose levels predict death after acute myocardial infarction (AMI). However, only diabetes history (and not glucose levels) is routinely considered in AMI risk assessment. Methods We conducted a post hoc analysis of 2 randomized controlled trials of AMI with ST-segment elevation to compare the prognostic value of inhospital glucose levels with diabetes history in 30,536 subjects. Average inhospital glucose (mean of glucose levels at admission, 6 hours, and 24 hours), diabetes history, and death at 30 days (occurring in 2,808 subjects) were documented. Results Average glucose predicted 30-day death (OR 1.10 per 1-mmol/L [18-mg/dL] increase, 95% CI 1.09-1.11, P < .0001); this was unchanged after adjusting for diabetes history. In contrast, diabetes history alone predicted 30-day death (OR 1.63, 95% CI 1.48-1.78, P < .0001), but not after adjusting for average glucose (OR 0.98, 95% CI 0.88-1.09, P = .72). The C-indices (areas under the receiver operating characteristic curves) for 30-day death were 0.54 for diabetes history alone, 0.64 for average glucose alone, and 0.64 for glucose plus diabetes. Higher glucose levels predicted death in patients with and without diabetes history, but this relationship was more steep in nondiabetic subjects such that their rate of 30-day death (13.2%) matched that of diabetic patients (13.7%) when average glucose was ≥144 mg/dL (8 mmol/L) ( P = .55 after multivariable adjustment). Conclusions Although diabetes history is routinely considered in the risk stratification of AMI patients, inhospital glucose levels are a much stronger predictor of death and should be incorporated in their risk assessment. Patients with AMI with inhospital glucose ≥144 mg/dL have a very high risk of death regardless of diabetes history. |
| doi_str_mv | 10.1016/j.ahj.2008.12.007 |
| format | Article |
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However, only diabetes history (and not glucose levels) is routinely considered in AMI risk assessment. Methods We conducted a post hoc analysis of 2 randomized controlled trials of AMI with ST-segment elevation to compare the prognostic value of inhospital glucose levels with diabetes history in 30,536 subjects. Average inhospital glucose (mean of glucose levels at admission, 6 hours, and 24 hours), diabetes history, and death at 30 days (occurring in 2,808 subjects) were documented. Results Average glucose predicted 30-day death (OR 1.10 per 1-mmol/L [18-mg/dL] increase, 95% CI 1.09-1.11, P < .0001); this was unchanged after adjusting for diabetes history. In contrast, diabetes history alone predicted 30-day death (OR 1.63, 95% CI 1.48-1.78, P < .0001), but not after adjusting for average glucose (OR 0.98, 95% CI 0.88-1.09, P = .72). The C-indices (areas under the receiver operating characteristic curves) for 30-day death were 0.54 for diabetes history alone, 0.64 for average glucose alone, and 0.64 for glucose plus diabetes. Higher glucose levels predicted death in patients with and without diabetes history, but this relationship was more steep in nondiabetic subjects such that their rate of 30-day death (13.2%) matched that of diabetic patients (13.7%) when average glucose was ≥144 mg/dL (8 mmol/L) ( P = .55 after multivariable adjustment). Conclusions Although diabetes history is routinely considered in the risk stratification of AMI patients, inhospital glucose levels are a much stronger predictor of death and should be incorporated in their risk assessment. Patients with AMI with inhospital glucose ≥144 mg/dL have a very high risk of death regardless of diabetes history.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2008.12.007</identifier><identifier>PMID: 19332208</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Acute coronary syndromes ; Biological and medical sciences ; Blood Glucose - metabolism ; Blood pressure ; Cardiology. Vascular system ; Cardiovascular ; Clinical trials ; Confidence intervals ; Coronary heart disease ; Diabetes ; Diabetes Mellitus - blood ; Diabetes Mellitus - epidemiology ; Diabetes. Impaired glucose tolerance ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Female ; Follow-Up Studies ; Glucose ; Heart ; Heart attacks ; Heart rate ; Hospitalization ; Humans ; Inpatients ; Logistics ; Male ; Medical research ; Medical sciences ; Middle Aged ; Morbidity - trends ; Mortality ; Myocardial Infarction - blood ; Myocardial Infarction - epidemiology ; Myocarditis. Cardiomyopathies ; Ontario - epidemiology ; Prognosis ; Risk Assessment - methods ; Risk Factors ; Statistical methods ; Studies ; Survival Rate - trends</subject><ispartof>The American heart journal, 2009-04, Vol.157 (4), p.763-770</ispartof><rights>Mosby, Inc.</rights><rights>2009 Mosby, Inc.</rights><rights>2009 INIST-CNRS</rights><rights>Copyright Elsevier Limited Apr 2009</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c464t-6267e5b5bdbd298ef06a7141d8855470c900f5db2d9cf32d4011a90c99da73d63</citedby><cites>FETCH-LOGICAL-c464t-6267e5b5bdbd298ef06a7141d8855470c900f5db2d9cf32d4011a90c99da73d63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1504590590?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21416211$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19332208$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Goyal, Abhinav, MD, MHS</creatorcontrib><creatorcontrib>Mehta, Shamir R., MD, MSc</creatorcontrib><creatorcontrib>Gerstein, Hertzel C., MD, MSc</creatorcontrib><creatorcontrib>Díaz, Rafael, MD</creatorcontrib><creatorcontrib>Afzal, Rizwan, MSc</creatorcontrib><creatorcontrib>Xavier, Denis, MD</creatorcontrib><creatorcontrib>Zhu, Jun, MD</creatorcontrib><creatorcontrib>Pais, Prem, MD, MSc</creatorcontrib><creatorcontrib>Lisheng, Liu, MD</creatorcontrib><creatorcontrib>Kazmi, Khawar A., MD</creatorcontrib><creatorcontrib>Zubaid, Mohammad, MD</creatorcontrib><creatorcontrib>Piegas, Leopoldo S., MD, PhD</creatorcontrib><creatorcontrib>Widimsky, Petr, MD, DrSC</creatorcontrib><creatorcontrib>Budaj, Andrzej, MD, PhD</creatorcontrib><creatorcontrib>Avezum, Alvaro, MD, PhD</creatorcontrib><creatorcontrib>Yusuf, Salim, MBBS, DPhil</creatorcontrib><title>Glucose levels compared with diabetes history in the risk assessment of patients with acute myocardial infarction</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Background Both a history of diabetes mellitus and elevated inhospital glucose levels predict death after acute myocardial infarction (AMI). However, only diabetes history (and not glucose levels) is routinely considered in AMI risk assessment. Methods We conducted a post hoc analysis of 2 randomized controlled trials of AMI with ST-segment elevation to compare the prognostic value of inhospital glucose levels with diabetes history in 30,536 subjects. Average inhospital glucose (mean of glucose levels at admission, 6 hours, and 24 hours), diabetes history, and death at 30 days (occurring in 2,808 subjects) were documented. Results Average glucose predicted 30-day death (OR 1.10 per 1-mmol/L [18-mg/dL] increase, 95% CI 1.09-1.11, P < .0001); this was unchanged after adjusting for diabetes history. In contrast, diabetes history alone predicted 30-day death (OR 1.63, 95% CI 1.48-1.78, P < .0001), but not after adjusting for average glucose (OR 0.98, 95% CI 0.88-1.09, P = .72). The C-indices (areas under the receiver operating characteristic curves) for 30-day death were 0.54 for diabetes history alone, 0.64 for average glucose alone, and 0.64 for glucose plus diabetes. Higher glucose levels predicted death in patients with and without diabetes history, but this relationship was more steep in nondiabetic subjects such that their rate of 30-day death (13.2%) matched that of diabetic patients (13.7%) when average glucose was ≥144 mg/dL (8 mmol/L) ( P = .55 after multivariable adjustment). Conclusions Although diabetes history is routinely considered in the risk stratification of AMI patients, inhospital glucose levels are a much stronger predictor of death and should be incorporated in their risk assessment. Patients with AMI with inhospital glucose ≥144 mg/dL have a very high risk of death regardless of diabetes history.</description><subject>Acute coronary syndromes</subject><subject>Biological and medical sciences</subject><subject>Blood Glucose - metabolism</subject><subject>Blood pressure</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Clinical trials</subject><subject>Confidence intervals</subject><subject>Coronary heart disease</subject><subject>Diabetes</subject><subject>Diabetes Mellitus - blood</subject><subject>Diabetes Mellitus - epidemiology</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Glucose</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Heart rate</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Inpatients</subject><subject>Logistics</subject><subject>Male</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Morbidity - trends</subject><subject>Mortality</subject><subject>Myocardial Infarction - blood</subject><subject>Myocardial Infarction - epidemiology</subject><subject>Myocarditis. Cardiomyopathies</subject><subject>Ontario - epidemiology</subject><subject>Prognosis</subject><subject>Risk Assessment - methods</subject><subject>Risk Factors</subject><subject>Statistical methods</subject><subject>Studies</subject><subject>Survival Rate - trends</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kl2L1TAQhoso7nH1B3gjAdG71knapi2CIIuuwoIX6nVIkykn3bY5m0lXzr835Rxc2AshkA-edzIz72TZaw4FBy4_jIXej4UAaAsuCoDmSbbj0DW5bKrqabYDAJG3DZQX2QuiMV2laOXz7IJ3ZSkEtLvs7npajSdkE97jRMz4-aADWvbHxT2zTvcYkdjeUfThyNzC4h5ZcHTLNBESzbhE5gd20NGlI52E2qwR2Xz0RocUZErCQQcTnV9eZs8GPRG-Ou-X2e-vX35dfctvflx_v_p8k5tKVjGXQjZY93Vveyu6FgeQuuEVt21b11UDpgMYatsL25mhFLYCznWXnjurm9LK8jJ7f4p7CP5uRYpqdmRwmvSCfiUlG-h4XfMEvn0Ejn4NS8pN8RqquoO0EsVPlAmeKOCgDsHNOhwVB7W5oUaV3FCbG4oLldxImjfnyGs_o31QnNufgHdnQJPR0xD0Yhz940SqVwq-pfjxxCWL8N5hUGRStw1aF9BEZb37bxqfHqnN5BaXPrzFI9JDtYqSQP3cxmabGmiBQy14-Rc40rzF</recordid><startdate>20090401</startdate><enddate>20090401</enddate><creator>Goyal, Abhinav, MD, MHS</creator><creator>Mehta, Shamir R., MD, MSc</creator><creator>Gerstein, Hertzel C., MD, MSc</creator><creator>Díaz, Rafael, MD</creator><creator>Afzal, Rizwan, MSc</creator><creator>Xavier, Denis, MD</creator><creator>Zhu, Jun, MD</creator><creator>Pais, Prem, MD, MSc</creator><creator>Lisheng, Liu, MD</creator><creator>Kazmi, Khawar A., MD</creator><creator>Zubaid, Mohammad, MD</creator><creator>Piegas, Leopoldo S., MD, PhD</creator><creator>Widimsky, Petr, MD, DrSC</creator><creator>Budaj, Andrzej, MD, PhD</creator><creator>Avezum, Alvaro, MD, PhD</creator><creator>Yusuf, Salim, MBBS, DPhil</creator><general>Mosby, Inc</general><general>Mosby</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20090401</creationdate><title>Glucose levels compared with diabetes history in the risk assessment of patients with acute myocardial infarction</title><author>Goyal, Abhinav, MD, MHS ; Mehta, Shamir R., MD, MSc ; Gerstein, Hertzel C., MD, MSc ; Díaz, Rafael, MD ; Afzal, Rizwan, MSc ; Xavier, Denis, MD ; Zhu, Jun, MD ; Pais, Prem, MD, MSc ; Lisheng, Liu, MD ; Kazmi, Khawar A., MD ; Zubaid, Mohammad, MD ; Piegas, Leopoldo S., MD, PhD ; Widimsky, Petr, MD, DrSC ; Budaj, Andrzej, MD, PhD ; Avezum, Alvaro, MD, PhD ; Yusuf, Salim, MBBS, DPhil</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c464t-6267e5b5bdbd298ef06a7141d8855470c900f5db2d9cf32d4011a90c99da73d63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Acute coronary syndromes</topic><topic>Biological and medical sciences</topic><topic>Blood Glucose - metabolism</topic><topic>Blood pressure</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Clinical trials</topic><topic>Confidence intervals</topic><topic>Coronary heart disease</topic><topic>Diabetes</topic><topic>Diabetes Mellitus - blood</topic><topic>Diabetes Mellitus - epidemiology</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Glucose</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Heart rate</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Inpatients</topic><topic>Logistics</topic><topic>Male</topic><topic>Medical research</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Morbidity - trends</topic><topic>Mortality</topic><topic>Myocardial Infarction - blood</topic><topic>Myocardial Infarction - epidemiology</topic><topic>Myocarditis. Cardiomyopathies</topic><topic>Ontario - epidemiology</topic><topic>Prognosis</topic><topic>Risk Assessment - methods</topic><topic>Risk Factors</topic><topic>Statistical methods</topic><topic>Studies</topic><topic>Survival Rate - trends</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Goyal, Abhinav, MD, MHS</creatorcontrib><creatorcontrib>Mehta, Shamir R., MD, MSc</creatorcontrib><creatorcontrib>Gerstein, Hertzel C., MD, MSc</creatorcontrib><creatorcontrib>Díaz, Rafael, MD</creatorcontrib><creatorcontrib>Afzal, Rizwan, MSc</creatorcontrib><creatorcontrib>Xavier, Denis, MD</creatorcontrib><creatorcontrib>Zhu, Jun, MD</creatorcontrib><creatorcontrib>Pais, Prem, MD, MSc</creatorcontrib><creatorcontrib>Lisheng, Liu, MD</creatorcontrib><creatorcontrib>Kazmi, Khawar A., MD</creatorcontrib><creatorcontrib>Zubaid, Mohammad, MD</creatorcontrib><creatorcontrib>Piegas, Leopoldo S., MD, PhD</creatorcontrib><creatorcontrib>Widimsky, Petr, MD, DrSC</creatorcontrib><creatorcontrib>Budaj, Andrzej, MD, PhD</creatorcontrib><creatorcontrib>Avezum, Alvaro, MD, PhD</creatorcontrib><creatorcontrib>Yusuf, Salim, MBBS, DPhil</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Goyal, Abhinav, MD, MHS</au><au>Mehta, Shamir R., MD, MSc</au><au>Gerstein, Hertzel C., MD, MSc</au><au>Díaz, Rafael, MD</au><au>Afzal, Rizwan, MSc</au><au>Xavier, Denis, MD</au><au>Zhu, Jun, MD</au><au>Pais, Prem, MD, MSc</au><au>Lisheng, Liu, MD</au><au>Kazmi, Khawar A., MD</au><au>Zubaid, Mohammad, MD</au><au>Piegas, Leopoldo S., MD, PhD</au><au>Widimsky, Petr, MD, DrSC</au><au>Budaj, Andrzej, MD, PhD</au><au>Avezum, Alvaro, MD, PhD</au><au>Yusuf, Salim, MBBS, DPhil</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Glucose levels compared with diabetes history in the risk assessment of patients with acute myocardial infarction</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2009-04-01</date><risdate>2009</risdate><volume>157</volume><issue>4</issue><spage>763</spage><epage>770</epage><pages>763-770</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>Background Both a history of diabetes mellitus and elevated inhospital glucose levels predict death after acute myocardial infarction (AMI). However, only diabetes history (and not glucose levels) is routinely considered in AMI risk assessment. Methods We conducted a post hoc analysis of 2 randomized controlled trials of AMI with ST-segment elevation to compare the prognostic value of inhospital glucose levels with diabetes history in 30,536 subjects. Average inhospital glucose (mean of glucose levels at admission, 6 hours, and 24 hours), diabetes history, and death at 30 days (occurring in 2,808 subjects) were documented. Results Average glucose predicted 30-day death (OR 1.10 per 1-mmol/L [18-mg/dL] increase, 95% CI 1.09-1.11, P < .0001); this was unchanged after adjusting for diabetes history. In contrast, diabetes history alone predicted 30-day death (OR 1.63, 95% CI 1.48-1.78, P < .0001), but not after adjusting for average glucose (OR 0.98, 95% CI 0.88-1.09, P = .72). The C-indices (areas under the receiver operating characteristic curves) for 30-day death were 0.54 for diabetes history alone, 0.64 for average glucose alone, and 0.64 for glucose plus diabetes. Higher glucose levels predicted death in patients with and without diabetes history, but this relationship was more steep in nondiabetic subjects such that their rate of 30-day death (13.2%) matched that of diabetic patients (13.7%) when average glucose was ≥144 mg/dL (8 mmol/L) ( P = .55 after multivariable adjustment). Conclusions Although diabetes history is routinely considered in the risk stratification of AMI patients, inhospital glucose levels are a much stronger predictor of death and should be incorporated in their risk assessment. Patients with AMI with inhospital glucose ≥144 mg/dL have a very high risk of death regardless of diabetes history.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>19332208</pmid><doi>10.1016/j.ahj.2008.12.007</doi><tpages>8</tpages></addata></record> |
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| recordid | cdi_proquest_miscellaneous_67091551 |
| source | MEDLINE; Elsevier ScienceDirect Journals Complete; ProQuest Central UK/Ireland |
| subjects | Acute coronary syndromes Biological and medical sciences Blood Glucose - metabolism Blood pressure Cardiology. Vascular system Cardiovascular Clinical trials Confidence intervals Coronary heart disease Diabetes Diabetes Mellitus - blood Diabetes Mellitus - epidemiology Diabetes. Impaired glucose tolerance Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Female Follow-Up Studies Glucose Heart Heart attacks Heart rate Hospitalization Humans Inpatients Logistics Male Medical research Medical sciences Middle Aged Morbidity - trends Mortality Myocardial Infarction - blood Myocardial Infarction - epidemiology Myocarditis. Cardiomyopathies Ontario - epidemiology Prognosis Risk Assessment - methods Risk Factors Statistical methods Studies Survival Rate - trends |
| title | Glucose levels compared with diabetes history in the risk assessment of patients with acute myocardial infarction |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-28T13%3A12%3A18IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Glucose%20levels%20compared%20with%20diabetes%20history%20in%20the%20risk%20assessment%20of%20patients%20with%20acute%20myocardial%20infarction&rft.jtitle=The%20American%20heart%20journal&rft.au=Goyal,%20Abhinav,%20MD,%20MHS&rft.date=2009-04-01&rft.volume=157&rft.issue=4&rft.spage=763&rft.epage=770&rft.pages=763-770&rft.issn=0002-8703&rft.eissn=1097-6744&rft.coden=AHJOA2&rft_id=info:doi/10.1016/j.ahj.2008.12.007&rft_dat=%3Cproquest_cross%3E3238056611%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1504590590&rft_id=info:pmid/19332208&rft_els_id=1_s2_0_S0002870308010521&rfr_iscdi=true |