Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 2, Number 4, August 2011, pages 160-167

On Arrival High Blood Glucose Level is Associated With Detrimental and Fatal Hospitalization Outcomes for Acute Coronary Syndrome

Figure 1. Left ventricular systolic dysfunction developed more frequently in patients with on arrival high blood glucose than those with normal blood glucose (80% versus 37%, P = 0.001).

Figure 2. Correlation between on arrival blood glucose level with left ventricular ejection fraction. There is significantly inverse correlation between on arrival blood glucose level and left ventricular ejection fraction (r = - 0.42, P = 0.001).

**Table 1.** Characteristic of Study Patients According to Glucose Level
Characteristics	High Glucose (n = 53)	Normal Glucose (n = 95)	P value
AMI: acute myocardial infarction; BP: blood pressure; HDL: high density lipoprotein, IHD: ischemic heart disease; LDL: low density lipoprotein; WBC: white blood cells.
Sex, n (%)			0.03
Male	37 (70)	81 (85)
Female	16 (30)	14 (15)
Age,year, mean ± SD	57.4 ± 8.1	56.4 ± 9.8	0.56
Medical history, n (%)
Diabetes mellitus	21 (40)	7 (8)	< 0.001
Hypertension	33 (64)	45 (48)	0.08
Previous IHD	17 (33)	42 (45)	0.14
Current smoker	16 (30)	38 (40)	0.26
Clinical, mean ± SD
Systolic BP	129.9 ± 25.3	129.4 ± 27.3	0.91
Diastolic BP	78.3 ± 19.4	78.0 ± 14.1	0.94
Heart rate	88.2 ± 20.4	79.3 ± 18.9	0.01
Laboratory, mean ± SD
Hemoglobin, g/dL	14.1 ± 1.5	14.1 ± 1.5	0.65
WBC count, x 10³/mm³	12.2 ± 3.8	10.0 ± 3.5	0.001
Platelet count, x10³/mm³	250.7 ± 71.4	241.4 ± 66.6	0.44
Creatinine, mg/dL	1.4 ± 0.7	1.3 ± 0.4	0.22
Glucose, mg/dL	234.8 ± 103.9	107.1 ± 17.7	< 0.001
Total cholesterol, mg/L	202.0 ± 58.5	196.1 ± 44.9	0.52
LDL cholesterol, mg/dL	144.9 ± 47.8	137.8 ± 37.9	0.29
HDL cholesterol, mg/dL	38.9 ± 10.5	40.9 ± 18.2	0.50
Triglyceride, mg/dL	136.6 ± 73.2	138.3 ± 83.0	0.96
Troponin I, ng/mL	14.4 ± 27.8	4.7 ± 8.2	0.007
Diagnosis, n (%)
AMI	46 (87)	57 (60)	0.001
Unstable angina	7 (13)	38 (40)	0.001

Table 1. Characteristic of Study Patients According to Glucose Level

Characteristics

High Glucose (n = 53)

Normal Glucose (n = 95)

P value

AMI: acute myocardial infarction; BP: blood pressure; HDL: high density lipoprotein, IHD: ischemic heart disease; LDL: low density lipoprotein; WBC: white blood cells.

Sex, n (%)

0.03

Male

37 (70)

81 (85)

Female

16 (30)

14 (15)

Age,year, mean ± SD

57.4 ± 8.1

56.4 ± 9.8

0.56

Medical history, n (%)

Diabetes mellitus

21 (40)

7 (8)

< 0.001

Hypertension

33 (64)

45 (48)

0.08

Previous IHD

17 (33)

42 (45)

0.14

Current smoker

16 (30)

38 (40)

0.26

Clinical, mean ± SD

Systolic BP

129.9 ± 25.3

129.4 ± 27.3

0.91

Diastolic BP

78.3 ± 19.4

78.0 ± 14.1

0.94

Heart rate

88.2 ± 20.4

79.3 ± 18.9

0.01

Laboratory, mean ± SD

Hemoglobin, g/dL

14.1 ± 1.5

0.65

WBC count, x 10³/mm³

12.2 ± 3.8

10.0 ± 3.5

0.001

Platelet count, x10³/mm³

250.7 ± 71.4

241.4 ± 66.6

0.44

Creatinine, mg/dL

1.4 ± 0.7

1.3 ± 0.4

0.22

Glucose, mg/dL

234.8 ± 103.9

107.1 ± 17.7

< 0.001

Total cholesterol, mg/L

202.0 ± 58.5

196.1 ± 44.9

0.52

LDL cholesterol, mg/dL

144.9 ± 47.8

137.8 ± 37.9

0.29

HDL cholesterol, mg/dL

38.9 ± 10.5

40.9 ± 18.2

0.50

Triglyceride, mg/dL

136.6 ± 73.2

138.3 ± 83.0

0.96

Troponin I, ng/mL

14.4 ± 27.8

4.7 ± 8.2

0.007

Diagnosis, n (%)

AMI

46 (87)

57 (60)

0.001

Unstable angina

7 (13)

38 (40)

0.001

**Table 2.** Correlation Between On-arrival Blood Glucose Level With Other Variables
Variables	r	P value
BP: blood pressure; HDL: high density lipoprotein; LDL: low density lipoprotein; WBC: white blood cells.

Age	-0.01	0.91
Systolic BP	-0.05	0.55
Diastolic BP	-0.03	0.76
Heart rate	0.26	0.001
Hemoglobin	-0.06	0.46
WBC count	0.36	< 0.001
Platelet count	0.02	0.83
Creatinine	0.04	0.60
Total cholesterol	-0.19	0.20
LDL cholesterol	-0.15	0.07
HDL cholesterol	0.10	0.61
Triglyceride	-0.08	0.76
Troponin I	0.33	< 0.001

Table 2. Correlation Between On-arrival Blood Glucose Level With Other Variables

Variables

P value

BP: blood pressure; HDL: high density lipoprotein; LDL: low density lipoprotein; WBC: white blood cells.

Age

-0.01

0.91

Systolic BP

-0.05

0.55

Diastolic BP

-0.03

0.76

Heart rate

0.26

0.001

Hemoglobin

-0.06

0.46

WBC count

0.36

< 0.001

Platelet count

0.02

0.83

Creatinine

0.04

0.60

Total cholesterol

-0.19

0.20

LDL cholesterol

-0.15

0.07

HDL cholesterol

0.10

0.61

Triglyceride

-0.08

0.76

Troponin I

0.33

< 0.001

**Table 3.** Medication During Hospitalization
Medication	High Glucose (n = 53)	Normal Glucose (n = 95)	P value
ACE: angiotensin converting enzym.
Medication
Glucose control, n (%)			< 0.001
Insulin	24 (45)	0 (0)
Sulfonylurea	1 (2)	3 (3)
Revascularization, n (%)			0.87
Percutaneus Intervention	3 (33)	6 (66)
Thrombolysis	12 (23)	10 (10)
Heparinization, n (%)			0.47
Low molecular weight	39 (74)	78 (82)
Unfractioned	11 (20)	13 (14)
Antiplatelet, n (%)			0.18
Aspirin	52 (99)	95 (100)
Clopidogrel	52 (99)	95 (100)
Beta blocker, n (%)	12 (21)	19 (20)	0.71
ACE inhibitor, n (%)	27 (51)	54 (57)	0.49

Table 3. Medication During Hospitalization

Medication

High Glucose (n = 53)

Normal Glucose (n = 95)

P value

ACE: angiotensin converting enzym.

Medication

Glucose control, n (%)

< 0.001

Insulin

24 (45)

0 (0)

Sulfonylurea

1 (2)

3 (3)

Revascularization, n (%)

0.87

Percutaneus Intervention

3 (33)

6 (66)

Thrombolysis

12 (23)

10 (10)

Heparinization, n (%)

0.47

Low molecular weight

39 (74)

78 (82)

Unfractioned

11 (20)

13 (14)

Antiplatelet, n (%)

0.18

Aspirin

52 (99)

95 (100)

Clopidogrel

52 (99)

95 (100)

Beta blocker, n (%)

12 (21)

19 (20)

0.71

ACE inhibitor, n (%)

27 (51)

54 (57)

0.49

**Table 4.** High Blood Glucose and Hospitalization Events
Hospitalization events	High Glucose (n = 53)	Normal Glucose (n = 95)	P value
AHF: acute heart failure.
Hospital mortality, n (%)	6 (11)	2 (2)	0.03
Haemodynamic disturbances
On arrival AHF, n (%)	23 (43)	15 (16)	< 0.001
Subsequent AHF, n (%)	30 (60)	20 (20)	< 0.001
Cardiogenic shock, n (%)	5 (10)	1 (1)	0.02
Heart rhythm disorders, n (%)	21 (40)	17 (18)	0.004
Atrial fibrillation	5 (9)	4 (4)
High degree atrioventricular lock	3 (6)	6 (6)
Ventricular extrasystole	8 (15)	4 (4)
Ventricular tachycardia/fibrillation	5 (9)	3 (3)
Sudden arrhythmic death, n (%)	2 (4)	1 (1)	0.29

Table 4. High Blood Glucose and Hospitalization Events

Hospitalization events

High Glucose (n = 53)

Normal Glucose (n = 95)

P value

AHF: acute heart failure.

Hospital mortality, n (%)

6 (11)

2 (2)

0.03

Haemodynamic disturbances

On arrival AHF, n (%)

23 (43)

15 (16)

< 0.001

Subsequent AHF, n (%)

30 (60)

20 (20)

< 0.001

Cardiogenic shock, n (%)

5 (10)

1 (1)

0.02

Heart rhythm disorders, n (%)

21 (40)

17 (18)

0.004

Atrial fibrillation

5 (9)

4 (4)

High degree atrioventricular lock

3 (6)

6 (6)

Ventricular extrasystole

8 (15)

4 (4)

Ventricular tachycardia/fibrillation

5 (9)

3 (3)

Sudden arrhythmic death, n (%)

2 (4)

1 (1)

0.29

**Table 5.** Stepwise Multivariate Logistic Regression Analysis for Predictors of Hospitalization Events and Mortality
Variables	Hospitalization Events	Mortality
OR: odds ratio; CI: confidence interval; AMI: acute myocardial infarction; WBC: white blood cells.
High blood glucose	2.3 (1.1-4.9)	0.03	6.9 (1.2-38.6)	0.03
AMI	3.7 (1.4-9.4)	0.01	-	0.17
Creatinine value	2.1 (0.9-4.3)	0.05	-	0.37
Age in years	-	0.18	1.1 (1.0-1.2)	0.03
WBC count	-	0.55	-	0.42

Table 5. Stepwise Multivariate Logistic Regression Analysis for Predictors of Hospitalization Events and Mortality

Variables

Hospitalization Events

Mortality

OR (95% CI)

P value

OR (95% CI)

P value

OR: odds ratio; CI: confidence interval; AMI: acute myocardial infarction; WBC: white blood cells.

High blood glucose

2.3 (1.1-4.9)

0.03

6.9 (1.2-38.6)

0.03

AMI

3.7 (1.4-9.4)

0.01

0.17

Creatinine value

2.1 (0.9-4.3)

0.05

0.37

Age in years

0.18

1.1 (1.0-1.2)

0.03

WBC count

0.55

0.42