Hyperglykämie

BackgroundRecent studies have shown increased mortality in patients admitted for acute coronary syndrome (ACS) who exhibit any high levels indicating hyperglycemia (e.g., 180 or 200 mg/dl). Based on this observation we investigated the question of whether hyperglycemia, defined as the clinically relevant level of 6.67 mmol/l (120 mg/dl), has an effect on 15- and 180-day mortality.MethodsA total of 161 patients who presented with ACS were retrospectively divided into two groups based on the blood glucose level (BGL) upon admittance: group A: BGL ≥ 6.67 mmol/l (120 mg/dl) and group B: < 6.67 mmol/l. Cardiovascular risk factors, standard 12-channel ECG, creatine kinase, troponin I, C-reactive protein, Killip classification, TIMI 1 flow phenomena, vascular status (one- to three-vessel disease), left ventricular ejection fraction, and survival at 15 and 180 days were determined. For statistical analysis the mean, standard deviation, Student’s t test, chi-square test, Fisher’s exact test, long-rank test, and Kaplan-Meier analysis were employed (significance set at p < 0.05).ResultsOf the 161 patients, 104 (64.6%) were considered to be hyperglycemic upon admission; 57 patients (35.4%) were in the control group. There was a significantly high occurrence of the cardiovascular risk factors hypertension (p = 0.05) and diabetes mellitus (p < 0.001) and a high proportion of women (p = 0.04) in the group of hyperglycemic patients. There was no significant difference between the two groups with regard to 180-day (p = 0.49) or 15-day mortality (p = 0.22). Data from nine patients (5.6%) were deleted. Seven patients (4.3%) died within the first 15 days, all in cardiogenic shock (100%), six of whom were categorized in the group of hyperglycemic patients and exhibited hyperlipoproteinemia. These patients who died with the first 15 days demonstrated a significantly higher incidence of TIMI 1 flow phenomena (p = 0.01), left ventricular ejection fraction < 30% (p < 0.001), and cardiogenic shock (p < 0.001).ConclusionsIn the context of ACS, hyperglycemia occurs more frequently in women, diabetics, and subjects with arterial hypertension. Since hyperlipoproteinemia was present in five of the six patients (85.7%) who died within the first 15 days, there could be a need for aggressive antihyperlipidemic treatment with the goal of reducing mortality. Hyperglycemia does not constitute an independent predictor of either 15- or 180-day mortality. The mortality rate is associated with increased occurrence of cardiogenic shock, ejection fractions < 30%, and TIMI 1 flows.