Association between glucose variability and adverse in-hospital outcomes for Chinese patients with acute coronary syndrome

Objectives: To investigate the association between mean blood glucose (MBG) and glucose variability (GV) during hospitalization, and adverse in-hospital outcomes for patients with acute coronary syndrome (ACS). Methods: This is a retrospective cohort study and conducted in 2 tertiary hospitals in Beijing, China. All data were collected from the medical records concerning ACS patients admitted to the hospital between January 2003 to December 2006. Hyperglycemia was related to clinical outcomes (including major adverse cardiovascular events [MACEs] and in-hospital death) using coefficient of variation of blood glucose (GluCV) or mean blood glucose (MBG). Total cohort was stratified by GluCV or MBG quartiles. Diabetic and non-diabetic subgroups were then separately analyzed. Multivariate logistic regression analysis was performed to evaluate the independent risk factor of in-hospital death. Results: A total of 1756 cases were enrolled in this study. For total cohort or non-diabetic cohort, prevalence of adverse outcomes was higher in patients with higher MBG or GluCV (p for trend <0.001). For diabetic ACS patients, MACEs were found more common in MBG or GluCV quartiles (p for trend <0.001), in-hospital mortality increased across MBG (p for trend <0.001), or GluCV quartiles (p for trend=0.004). Multivariate logistic regression analysis showed that GluCV (odds ratio: 1.29) was a stronger predictor of in-hospital death than MBG (odds ratios: 1.20). Conclusions: The GluCV is a better discriminator of in-hospital mortality than MBG in ACS patients.