Abstract | BACKGROUND: METHODS: We included 308 consecutive ACS patients who underwent coronary angioplasty in this pilot observational study. Patients were separated into 3 groups: patients with proven diabetes mellitus (DM group) (n =55), nondiabetic patients with a normal glucose concentration at admission (NAG group) (n =175), and nondiabetic patients with AHG at presentation (AHG group) (n =78). Blood samples for glucose, insulin, and proinsulin measurements were obtained at admission. The primary end point of the study was all-cause mortality, which was assessed at a mean follow-up of 19 months (interquartile range, 12-28 months). RESULTS: Patients in the AHG and DM groups had significantly (P =0.048) higher all-cause mortality compared with the NAG group. A univariate Cox regression analysis revealed that the proinsulin concentration was significantly associated with all-cause mortality for all study participants (hazard ratio, 1.013; 95% CI, 1.002-1.024; P =0.023). AHG patients with increased proinsulin concentrations showed a mortality rate similar to that of DM patients but had a significantly higher mortality rate than patients with AHG and a low proinsulin concentration (χ² =7.57; P =0.006) and patients with NAG (with or without increased proinsulin) [χ² =7.66 (P =0.006) and 13.98 (P < 0.001), respectively]. A multivariate regression analysis revealed that the concentrations of glucose and proinsulin at admission were significant (P =0.002) predictors of all-cause mortality. CONCLUSIONS: An increased proinsulin concentration may be a marker for mortality in ACS patients with hyperglycemia at admission and without known diabetes. Further studies are needed to evaluate the role of metabolic parameters such as proinsulin.
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Authors | Serdar Farhan, Rudolf Jarai, Ioannis Tentzeris, Matthias K Freynhofer, Ivan Brozovic, Birgit Vogel, A Kautzky-Willer, Thomas Wascher, Johann Wojta, Kurt Huber |
Journal | Clinical chemistry
(Clin Chem)
Vol. 57
Issue 10
Pg. 1456-60
(Oct 2011)
ISSN: 1530-8561 [Electronic] England |
PMID | 21784763
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
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Topics |
- Acute Coronary Syndrome
(blood, complications, mortality, therapy)
- Aged
- Angioplasty
- Diabetes Mellitus
(blood, mortality)
- Female
- Humans
- Hyperglycemia
(blood, complications, mortality)
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Pilot Projects
- Proinsulin
(blood)
- Proportional Hazards Models
- Risk Assessment
- Stents
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