Skip to main content
Top
Published in: Clinical Research in Cardiology 3/2014

01-03-2014 | Original Paper

Admission glucose, fasting glucose, HbA1c levels and the SYNTAX score in non-diabetic patients undergoing coronary angiography

Authors: Yaron Arbel, Margalit Zlotnik, Amir Halkin, Ofer Havakuk, Shlomo Berliner, Itzhak Herz, Itay Rabinovich, Gad Keren, Shmuel Bazan, Ariel Finkelstein, Shmuel Banai

Published in: Clinical Research in Cardiology | Issue 3/2014

Login to get access

Abstract

Background

Pre-diabetic state is a major risk factor for the development of diabetes and cardiovascular events. Admission glucose, fasting glucose and HbA1c levels have an effect on prognosis in patients with pre-diabetes and in non-diabetic individuals. The aim of the present study was to investigate which of the following glucometabolic markers (admission glucose, fasting glucose and HbA1c levels) is correlated with the severity of coronary artery disease (CAD) in non-diabetic patients.

Methods

CAD severity according to SYNTAX score was prospectively evaluated in 226 non-diabetic patients hospitalized with myocardial infarction or stable angina and underwent coronary angiography. Glucose intolerance was assessed by serum admission glucose, fasting glucose and HbA1c levels. Logistic regression analysis was used to evaluate which glucometabolic factor has the strongest correlation with CAD severity.

Results

HbA1c was the only glucometabolic factor associated with SYNTAX score above 22 (OR = 3.03, CI 95 % 1.03–8.9, p = 0.04). HbA1c was also significantly associated with CAD severity in subgroup analysis (MI and stable angina).

Conclusions

In non-diabetic patients with myocardial infarction or stable angina, HbA1c levels correlate with CAD severity as measured by the SYNTAX score. No correlation was found between admission glucose or fasting glucose levels and CAD severity.
Literature
1.
go back to reference Milicevic Z, Raz I, Beattie SD, Campaigne BN, Sarwat S, Gromniak E, Kowalska I, Galic E, Tan M, Hanefeld M (2008) Natural history of cardiovascular disease in patients with diabetes: role of hyperglycemia. Diabetes Care 31(Suppl 2):S155–S160PubMedCrossRef Milicevic Z, Raz I, Beattie SD, Campaigne BN, Sarwat S, Gromniak E, Kowalska I, Galic E, Tan M, Hanefeld M (2008) Natural history of cardiovascular disease in patients with diabetes: role of hyperglycemia. Diabetes Care 31(Suppl 2):S155–S160PubMedCrossRef
2.
go back to reference Giugliano D, Ceriello A, Esposito K (2008) Glucose metabolism and hyperglycemia. Am J Clin Nutr 87:217S–222SPubMed Giugliano D, Ceriello A, Esposito K (2008) Glucose metabolism and hyperglycemia. Am J Clin Nutr 87:217S–222SPubMed
3.
go back to reference Peter P, Nuttall SL, Kendall MJ (2003) Insulin resistance—the new goal! J Clin Pharm Ther 28:167–174PubMedCrossRef Peter P, Nuttall SL, Kendall MJ (2003) Insulin resistance—the new goal! J Clin Pharm Ther 28:167–174PubMedCrossRef
4.
go back to reference Farhan S, Jarai R, Tentzeris I, Kautzky-Willer A, Samaha E, Smetana P, Jakl-Kotauschek G, Wojta J, Huber K (2012) Comparison of HbA1c and oral glucose tolerance test for diagnosis of diabetes in patients with coronary artery disease. Clin Res Cardiol 101:625–630PubMedCrossRef Farhan S, Jarai R, Tentzeris I, Kautzky-Willer A, Samaha E, Smetana P, Jakl-Kotauschek G, Wojta J, Huber K (2012) Comparison of HbA1c and oral glucose tolerance test for diagnosis of diabetes in patients with coronary artery disease. Clin Res Cardiol 101:625–630PubMedCrossRef
5.
go back to reference De Caterina R, Madonna R, Sourij H, Wascher T (2010) Glycaemic control in acute coronary syndromes: prognostic value and therapeutic options. Eur Heart J 31:1557–1564PubMedCrossRef De Caterina R, Madonna R, Sourij H, Wascher T (2010) Glycaemic control in acute coronary syndromes: prognostic value and therapeutic options. Eur Heart J 31:1557–1564PubMedCrossRef
6.
go back to reference Arbel Y, Rind E, Banai S, Halkin A, Berliner S, Herz I, Mashav N, Thurm T, Keren G, Finkelstein A (2012) Prevalence and predictors of slow flow in angiographically normal coronary arteries. Clin Hemorheol Microcirc 52:5–14PubMed Arbel Y, Rind E, Banai S, Halkin A, Berliner S, Herz I, Mashav N, Thurm T, Keren G, Finkelstein A (2012) Prevalence and predictors of slow flow in angiographically normal coronary arteries. Clin Hemorheol Microcirc 52:5–14PubMed
7.
go back to reference Arbel Y, Finkelstein A, Halkin A, Birati EY, Revivo M, Zuzut M, Shevach A, Berliner S, Herz I, Keren G (2012) Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis 225(2):456–460PubMedCrossRef Arbel Y, Finkelstein A, Halkin A, Birati EY, Revivo M, Zuzut M, Shevach A, Berliner S, Herz I, Keren G (2012) Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis 225(2):456–460PubMedCrossRef
8.
go back to reference Arbel Y, Banai S, Benhorin J, Finkelstein A, Herz I, Halkin A, Keren G, Yedgar S, Barashtein G, Berliner S (2012) Erythrocyte aggregation as a cause of slow flow in patients of acute coronary syndromes. Int J Cardiol 154:322–327PubMedCrossRef Arbel Y, Banai S, Benhorin J, Finkelstein A, Herz I, Halkin A, Keren G, Yedgar S, Barashtein G, Berliner S (2012) Erythrocyte aggregation as a cause of slow flow in patients of acute coronary syndromes. Int J Cardiol 154:322–327PubMedCrossRef
9.
go back to reference Arbel Y, Halkin A, Finkelstein A, Revivo M, Berliner S, Herz I, Keren G, Banai S (2013) Impact of estimated glomerular filtration rate on vascular disease extent and adverse cardiovascular events in patients without chronic kidney disease. Can J Cardiol 29(11):1374–1381PubMedCrossRef Arbel Y, Halkin A, Finkelstein A, Revivo M, Berliner S, Herz I, Keren G, Banai S (2013) Impact of estimated glomerular filtration rate on vascular disease extent and adverse cardiovascular events in patients without chronic kidney disease. Can J Cardiol 29(11):1374–1381PubMedCrossRef
10.
go back to reference Ringqvist I, Fisher LD, Mock M, Davis KB, Wedel H, Chaitman BR, Passamani E, Russell RO Jr, Alderman EL, Kouchoukas NT, Kaiser GC, Ryan TJ, Killip T, Fray D (1983) Prognostic value of angiographic indices of coronary artery disease from the Coronary Artery Surgery Study (CASS). J Clin Invest 71:1854–1866PubMedCentralPubMedCrossRef Ringqvist I, Fisher LD, Mock M, Davis KB, Wedel H, Chaitman BR, Passamani E, Russell RO Jr, Alderman EL, Kouchoukas NT, Kaiser GC, Ryan TJ, Killip T, Fray D (1983) Prognostic value of angiographic indices of coronary artery disease from the Coronary Artery Surgery Study (CASS). J Clin Invest 71:1854–1866PubMedCentralPubMedCrossRef
11.
go back to reference Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, van den Brand M, Van Dyck N, Russell ME, Mohr FW, Serruys PW (2005) The SYNTAX score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 1:219–227PubMed Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, van den Brand M, Van Dyck N, Russell ME, Mohr FW, Serruys PW (2005) The SYNTAX score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 1:219–227PubMed
12.
go back to reference Sadhu AR, Ang AC, Ingram-Drake LA, Martinez DS, Hsueh WA, Ettner SL (2008) Economic benefits of intensive insulin therapy in critically Ill patients: the targeted insulin therapy to improve hospital outcomes (TRIUMPH) project. Diabetes Care 31:1556–1561PubMedCentralPubMedCrossRef Sadhu AR, Ang AC, Ingram-Drake LA, Martinez DS, Hsueh WA, Ettner SL (2008) Economic benefits of intensive insulin therapy in critically Ill patients: the targeted insulin therapy to improve hospital outcomes (TRIUMPH) project. Diabetes Care 31:1556–1561PubMedCentralPubMedCrossRef
13.
go back to reference Verges B, Zeller M, Dentan G, Beer JC, Laurent Y, Janin-Manificat L, Makki H, Wolf JE, Cottin Y (2007) Impact of fasting glycemia on short-term prognosis after acute myocardial infarction. J Clin Endocrinol Metab 92:2136–2140PubMedCrossRef Verges B, Zeller M, Dentan G, Beer JC, Laurent Y, Janin-Manificat L, Makki H, Wolf JE, Cottin Y (2007) Impact of fasting glycemia on short-term prognosis after acute myocardial infarction. J Clin Endocrinol Metab 92:2136–2140PubMedCrossRef
14.
go back to reference Suleiman M, Hammerman H, Boulos M, Kapeliovich MR, Suleiman A, Agmon Y, Markiewicz W, Aronson D (2005) Fasting glucose is an important independent risk factor for 30-day mortality in patients with acute myocardial infarction: a prospective study. Circulation 111:754–760PubMedCrossRef Suleiman M, Hammerman H, Boulos M, Kapeliovich MR, Suleiman A, Agmon Y, Markiewicz W, Aronson D (2005) Fasting glucose is an important independent risk factor for 30-day mortality in patients with acute myocardial infarction: a prospective study. Circulation 111:754–760PubMedCrossRef
15.
go back to reference Kolman L, Hu YC, Montgomery DG, Gordon K, Eagle KA, Jackson EA (2009) Prognostic value of admission fasting glucose levels in patients with acute coronary syndrome. Am J Cardiol 104:470–474PubMedCrossRef Kolman L, Hu YC, Montgomery DG, Gordon K, Eagle KA, Jackson EA (2009) Prognostic value of admission fasting glucose levels in patients with acute coronary syndrome. Am J Cardiol 104:470–474PubMedCrossRef
16.
go back to reference Jensen CJ, Eberle HC, Nassenstein K, Schlosser T, Farazandeh M, Naber CK, Sabin GV, Bruder O (2011) Impact of hyperglycemia at admission in patients with acute ST-segment elevation myocardial infarction as assessed by contrast-enhanced MRI. Clin Res Cardiol 100:649–659PubMedCrossRef Jensen CJ, Eberle HC, Nassenstein K, Schlosser T, Farazandeh M, Naber CK, Sabin GV, Bruder O (2011) Impact of hyperglycemia at admission in patients with acute ST-segment elevation myocardial infarction as assessed by contrast-enhanced MRI. Clin Res Cardiol 100:649–659PubMedCrossRef
17.
go back to reference Dziewierz A, Giszterowicz D, Siudak Z, Rakowski T, Dubiel JS, Dudek D (2010) Admission glucose level and in-hospital outcomes in diabetic and non-diabetic patients with acute myocardial infarction. Clin Res Cardiol 99:715–721PubMedCrossRef Dziewierz A, Giszterowicz D, Siudak Z, Rakowski T, Dubiel JS, Dudek D (2010) Admission glucose level and in-hospital outcomes in diabetic and non-diabetic patients with acute myocardial infarction. Clin Res Cardiol 99:715–721PubMedCrossRef
18.
go back to reference Yang Z, Laubach VE, French BA, Kron IL (2009) Acute hyperglycemia enhances oxidative stress and exacerbates myocardial infarction by activating nicotinamide adenine dinucleotide phosphate oxidase during reperfusion. J Thorac Cardiovasc Surg 137:723–729PubMedCentralPubMedCrossRef Yang Z, Laubach VE, French BA, Kron IL (2009) Acute hyperglycemia enhances oxidative stress and exacerbates myocardial infarction by activating nicotinamide adenine dinucleotide phosphate oxidase during reperfusion. J Thorac Cardiovasc Surg 137:723–729PubMedCentralPubMedCrossRef
19.
go back to reference Ceriello A (2008) Cardiovascular effects of acute hyperglycaemia: pathophysiological underpinnings. Diabet Vasc Dis Res 5:260–268CrossRef Ceriello A (2008) Cardiovascular effects of acute hyperglycaemia: pathophysiological underpinnings. Diabet Vasc Dis Res 5:260–268CrossRef
20.
go back to reference Zarich SW, Nesto RW (2007) Implications and treatment of acute hyperglycemia in the setting of acute myocardial infarction. Circulation 115:e436–e439PubMedCrossRef Zarich SW, Nesto RW (2007) Implications and treatment of acute hyperglycemia in the setting of acute myocardial infarction. Circulation 115:e436–e439PubMedCrossRef
21.
go back to reference Bauters C, Ennezat PV, Tricot O, Lauwerier B, Lallemant R, Saadouni H, Quandalle P, Jaboureck O, Lamblin N, Le Tourneau T (2007) Stress hyperglycaemia is an independent predictor of left ventricular remodelling after first anterior myocardial infarction in non-diabetic patients. Eur Heart J 28:546–552PubMedCrossRef Bauters C, Ennezat PV, Tricot O, Lauwerier B, Lallemant R, Saadouni H, Quandalle P, Jaboureck O, Lamblin N, Le Tourneau T (2007) Stress hyperglycaemia is an independent predictor of left ventricular remodelling after first anterior myocardial infarction in non-diabetic patients. Eur Heart J 28:546–552PubMedCrossRef
22.
go back to reference Yosefy C (2003) Hyperglycaemia and its relation to cardiovascular morbidity and mortality: has it been resolved? Acta Diabetol 40(Suppl 2):S380–S388PubMedCrossRef Yosefy C (2003) Hyperglycaemia and its relation to cardiovascular morbidity and mortality: has it been resolved? Acta Diabetol 40(Suppl 2):S380–S388PubMedCrossRef
23.
go back to reference Akalin A, Temiz G, Akcar N, Sensoy B (2008) Short term effects of atorvastatin on endothelial functions and oxidized LDL levels in patients with type 2 diabetes. Endocr J 55(5):861–866PubMedCrossRef Akalin A, Temiz G, Akcar N, Sensoy B (2008) Short term effects of atorvastatin on endothelial functions and oxidized LDL levels in patients with type 2 diabetes. Endocr J 55(5):861–866PubMedCrossRef
24.
go back to reference Timmer JR, Ottervanger JP, Bilo HJ, Dambrink JH, Miedema K, Hoorntje JC, Zijlstra F (2006) Prognostic value of admission glucose and glycosylated haemoglobin levels in acute coronary syndromes. QJM: Mon J Assoc Physicians 99:237–243CrossRef Timmer JR, Ottervanger JP, Bilo HJ, Dambrink JH, Miedema K, Hoorntje JC, Zijlstra F (2006) Prognostic value of admission glucose and glycosylated haemoglobin levels in acute coronary syndromes. QJM: Mon J Assoc Physicians 99:237–243CrossRef
25.
go back to reference Karabulut A, Iltumur K, Toprak N, Tuzcu AK, Kara IH, Kaplan A, Aksu Y (2005) Insulin response to oral glucose loading and coronary artery disease in nondiabetics. Int Heart J 46:761–770PubMedCrossRef Karabulut A, Iltumur K, Toprak N, Tuzcu AK, Kara IH, Kaplan A, Aksu Y (2005) Insulin response to oral glucose loading and coronary artery disease in nondiabetics. Int Heart J 46:761–770PubMedCrossRef
26.
go back to reference Geisler T, Mueller K, Aichele S, Bigalke B, Stellos K, Htun P, Ninci E, Fateh-Moghadam S, May AE, Gawaz M (2010) Impact of inflammatory state and metabolic control on responsiveness to dual antiplatelet therapy in type 2 diabetics after PCI: prognostic relevance of residual platelet aggregability in diabetics undergoing coronary interventions. Clin Res Cardiol 99:743–752PubMedCrossRef Geisler T, Mueller K, Aichele S, Bigalke B, Stellos K, Htun P, Ninci E, Fateh-Moghadam S, May AE, Gawaz M (2010) Impact of inflammatory state and metabolic control on responsiveness to dual antiplatelet therapy in type 2 diabetics after PCI: prognostic relevance of residual platelet aggregability in diabetics undergoing coronary interventions. Clin Res Cardiol 99:743–752PubMedCrossRef
27.
go back to reference Hartge MM, Unger T, Kintscher U (2007) The endothelium and vascular inflammation in diabetes. Diabet Vasc Dis Res 4:84–88CrossRef Hartge MM, Unger T, Kintscher U (2007) The endothelium and vascular inflammation in diabetes. Diabet Vasc Dis Res 4:84–88CrossRef
28.
go back to reference Oswald GA, Yudkin JS (1987) Hyperglycaemia following acute myocardial infarction: the contribution of undiagnosed diabetes. Diabet Med 4:68–70PubMedCrossRef Oswald GA, Yudkin JS (1987) Hyperglycaemia following acute myocardial infarction: the contribution of undiagnosed diabetes. Diabet Med 4:68–70PubMedCrossRef
29.
go back to reference Ilany J, Marai I, Cohen O, Matetzky S, Gorfine M, Erez I, Hod H, Karasik A (2009) Glucose homeostasis abnormalities in cardiac intensive care unit patients. Acta Diabetol 46:209–216PubMedCrossRef Ilany J, Marai I, Cohen O, Matetzky S, Gorfine M, Erez I, Hod H, Karasik A (2009) Glucose homeostasis abnormalities in cardiac intensive care unit patients. Acta Diabetol 46:209–216PubMedCrossRef
30.
go back to reference Anantharaman R, Heatley M, Weston CF (2009) Hyperglycaemia in acute coronary syndromes: risk-marker or therapeutic target? Heart 95:697–703PubMedCrossRef Anantharaman R, Heatley M, Weston CF (2009) Hyperglycaemia in acute coronary syndromes: risk-marker or therapeutic target? Heart 95:697–703PubMedCrossRef
31.
go back to reference Undas A, Wiek I, Stepien E, Zmudka K, Tracz W (2008) Hyperglycemia is associated with enhanced thrombin formation, platelet activation, and fibrin clot resistance to lysis in patients with acute coronary syndrome. Diabetes Care 31:1590–1595PubMedCentralPubMedCrossRef Undas A, Wiek I, Stepien E, Zmudka K, Tracz W (2008) Hyperglycemia is associated with enhanced thrombin formation, platelet activation, and fibrin clot resistance to lysis in patients with acute coronary syndrome. Diabetes Care 31:1590–1595PubMedCentralPubMedCrossRef
32.
go back to reference Gustafsson I, Kistorp CN, James MK, Faber JO, Dickstein K, Hildebrandt PR (2007) Unrecognized glycometabolic disturbance as measured by hemoglobin A1c is associated with a poor outcome after acute myocardial infarction. Am Heart J 154:470–476PubMedCrossRef Gustafsson I, Kistorp CN, James MK, Faber JO, Dickstein K, Hildebrandt PR (2007) Unrecognized glycometabolic disturbance as measured by hemoglobin A1c is associated with a poor outcome after acute myocardial infarction. Am Heart J 154:470–476PubMedCrossRef
Metadata
Title
Admission glucose, fasting glucose, HbA1c levels and the SYNTAX score in non-diabetic patients undergoing coronary angiography
Authors
Yaron Arbel
Margalit Zlotnik
Amir Halkin
Ofer Havakuk
Shlomo Berliner
Itzhak Herz
Itay Rabinovich
Gad Keren
Shmuel Bazan
Ariel Finkelstein
Shmuel Banai
Publication date
01-03-2014
Publisher
Springer Berlin Heidelberg
Published in
Clinical Research in Cardiology / Issue 3/2014
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-013-0641-7

Other articles of this Issue 3/2014

Clinical Research in Cardiology 3/2014 Go to the issue