Abstract 1707: Admission Glucose and Cardiovascular Outcomes in Patients With Non-ST Elevation ACS: Observations From the MERLIN-TIMI 36 Trial
The association of hyperglycemia and adverse cardiac events in patients presenting with acute coronary syndrome has been described. However, more recently a possible relationship of hypoglycemia and adverse events has been recognized.
METHODS: We measured glucose at baseline in 6386 pts with non-ST elevation acute coronary syndromes (NSTE-ACS) participating in the MERLIN-TIMI 36 trial. Patients were followed for a median of 348 days for outcomes of cardiovascular death (CVD), recurrent myocardial infarction (MI), and heart failure (HF) which were centrally adjudicated.
RESULTS: Initial glucose was ≥140 mg/dL in 1797 subjects (28%), including 462 (26%) without prior diabetes mellitus (DM). Analyzed by category, compared with the group with initial glucose 80- <140mg/dL, a graded association was observed for increased CVD risk for those with glucose 140 –180mg/dL, and with >180mg/dL (3.5% vs. 6.2% vs. 7.1%, respectively; ptrend < 0.0001), with similar observations for HF and MI (figure⇓). The group with glucose < 80mg/dL had higher rates of CVD, HF, and MI when compared with those with glucose 80- < 140mg/dL (figure⇓). Adjusting for age, sex, prior MI, DM, CAD risk factors, and ACS type, the hazard for CVD remained significant for those with initial glucose 140 –180 mg/dL (Adj HR 1.5, 95%CI 1.1–2.1) and those with glucose >180 mg/dL, (Adj HR 1.9, 95% CI 1.4 –2.5). Similar stepwise increases in risk for MI and HF were observed after adjustment. There was a trend toward increased risk in those with hypoglycemia (figure⇓).
CONCLUSIONS: Initial glucose levels in patients with NSTE-ACS independently are associated with CV outcomes, including a U-shaped relationship with CV death, MI and HF.