One‐Year Mortality in Elderly Adults with Non‐ST‐Elevation Acute Coronary Syndrome: Effect of Diabetic Status and Admission Hyperglycemia. Issue 7 (10th June 2014)

• Record Type: Journal Article
• Authors: Savonitto, Stefano; Morici, Nuccia; Cavallini, Claudio; Antonicelli, Roberto; Petronio, Anna Sonia; Murena, Ernesto; Olivari, Zoran; Steffenino, Giuseppe; Bonechi, Francesco; Mafrici, Antonio; Toso, Anna; Piscione, Federico; Bolognese, Leonardo; De Servi, Stefano
• Is Part Of: Journal of the American Geriatrics Society. Volume 62:Issue 7(2014:Jul.)
• Page Start: 1297
• Page End: 1303
• Publication Date: 2014-06-10
• Subjects: Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.12900
• Languages: English
• ISSNs: 0002-8614

Abstract

<abstract abstract-type="main" id="jgs12900-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jgs12900-sec-0001" sec-type="section"> <title>Objectives</title> <p>To determine whether type 2 diabetes mellitus and hyperglycemia on admission should be considered independent predictors of mortality in elderly adults with acute coronary syndrome (ACS).</p> </sec> <sec id="jgs12900-sec-0002" sec-type="section"> <title>Design</title> <p>Prospective cohort study.</p> </sec> <sec id="jgs12900-sec-0003" sec-type="section"> <title>Setting</title> <p>Twenty‐three hospitals in Italy.</p> </sec> <sec id="jgs12900-sec-0004" sec-type="section"> <title>Participants</title> <p>Individuals aged 75 and older with non‐ST‐elevation ACS (NSTEACS) (mean age 82, 47% female) (N = 645).</p> </sec> <sec id="jgs12900-sec-0005" sec-type="section"> <title>Measurements</title> <p>Diabetic status and blood glucose levels were assessed on admission. Hyperglycemia was defined as glucose greater than 140 mg/dL. Multivariable Cox proportional hazard regression was used to assess the potential confounding effect of major covariates on the association between diabetic status, admission glucose, and 1‐year mortality.</p> </sec> <sec id="jgs12900-sec-0006" sec-type="section"> <title>Results</title> <p>A history of diabetes mellitus was found in 231 participants (35.8%), whereas 257 (39.8%) had hyperglycemia. Hyperglycemia was found in 171 participants with diabetes mellitus (70%) and 86 (21%) without diabetes mellitus. Participants with diabetes mellitus were significantly (<italic>P</italic> < .05) more likely to have had prior myocardial infarction and stroke and had lower ejection fraction and blood hemoglobin. Hyperglycemia was associated with lower (<italic>P</italic> < .05) ejection fraction and estimated glomerular filtration rate (eGFR). Diabetic status and hyperglycemia were associated with greater 1‐year mortality according to univariate analysis (54 participants with diabetes mellitus died (23.4%), versus 66 (15.9%) without diabetes mellitus (hazard ratio (HR) = 1.5 95% confidence interval (CI) = 1.0–2.1), and 60 participants with hyperglycemia died (23.3%), versus 60 (15.5%) without hyperglycemia (HR=1.6; 95% CI = 1.1–2.2), but this association was not statistically significant after adjustment for ejection fraction, age, blood hemoglobin, and eGFR.</p> </sec> <sec id="jgs12900-sec-0007" sec-type="section"> <title>Conclusion</title> <p>In elderly adults with NSTEACS, diabetes mellitus and hyperglycemia on admission are associated with higher mortality, mostly because of preexisting cardiovascular and renal damage.</p> </sec> </abstract>