Impact of admission glucose level and presence of diabetes mellitus on mortality in patients with non-ST-segment elevation acute coronary syndrome treated conservatively.

Elevated glucose level on admission is common in patients with acute coronary syndrome (ACS) and has been shown to be a strong predictor of adverse outcome in patients both with and without diabetes. The purpose of the study was to assess the impact of admission glucose on in-hospital mortality in patients with non-ST-segment elevation ACS treated in hospitals without on-site invasive facilities. We identified 807 patients with non-ST-segment elevation ACS treated conservatively in the 29 hospitals participating in the Krakow Registry of Acute Coronary Syndromes; 763 patients with complete admission glucose data were stratified according to admission glucose level. Of these, 24.2% had admission glucose level <5, 50.6% had a level 5 to 6.9, 10.9% had a level 7 to 8.9, 6.7% had a level 9 to 10.9, and 7.6% had a level > or =11 mmol/L. In-hospital mortality was higher in patients with higher admission glucose (admission glucose <5, 5 to 6.9, 7 to 8.9, 9 to 10.9, and > or =11 mmol/L: 0.5%, 2.6%, 7.2%, 9.8%, and 24.1% respectively, p <0.0001). Similarly, significant mortality difference was observed in patient subgroups stratified by admission glucose level and presence of diabetes mellitus and cardiogenic shock. Independent predictors of in-hospital death were age, cardiogenic shock, admission glucose, chronic obstructive pulmonary disease, and renal insufficiency. In conclusion, admission glucose level is a strong predictor of in-hospital death in patients with non-ST-segment elevation ACS remaining in hospitals without on-site invasive facilities. Impact of admission glucose on mortality is independent of diabetes and cardiogenic shock presence.