Abstract 12946: Among Patients With Acute Coronary Syndromes, is the Risk of Hyperglycemia for In-Hospital Mortality Similar in Men and Women?

Abstract

Introduction: Hyperglycemia is associated with higher in-hospital mortality in acute coronary syndromes (ACS) patients (pts). However, interaction between hyperglycemia, mortality and sex in ACS pts is poorly understood. Hypothesis: To analyze the relationship between hyperglycemia and in-hospital mortality stratified by sex. Methods: We analyzed 4633 ACS pts included in an administrative databank. Categorical variables were compared using the chi-square or Fisher exact tests as appropriate; continuous variables were compared by the Student’s t-test if Gaussian distribution, or Mann-Whitney test if not. Logistic regression test was used for the interaction analysis and adjusted models. ROC curves were developed and compared by the De Long test. The first glucose measurement obtained during hospitalization was utilized. Hyperglycemia was defined as glucose ≥126.5 mg/dL: best cut point, derived from the ROC curve for the whole population. Results: A) In comparison with men, women were older, with higher rates of hyperglycemia, hypertension and diabetes, and lower rates of prior MI, CABG, ST-elevation MI, and in-hospital PCI. B) As shown in figure there was a stronger association between hyperglycemia and in-hospital mortality in women (OR 3.34) than in men (OR 2.46 p-interaction <0.001). C) ROC analysis of the predictive value of hyperglycemia for in-hospital mortality showed areas under the curve (AUC) of 0.64 (95% CI 0.60-0.67), 0.62 (95% CI 0.58-0.66) and 0.66 (95% CI 0.61-0.71) resp. for the whole population, men, and women (P<0.01 for each), with no difference between men and women (P 0.23). D) Significant multivariate predictors of in-hospital mortality included: hyperglycemia, cardiogenic shock and age for both sexes; ST-elevation MI and in-hospital PCI only for men; and previous MI and in-hospital CABG only for women. Conclusions: In ACS pts, the association of hyperglycemia with higher in-hospital mortality is greater in women than in men.