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Usefulness of initial glucose level to improve acute coronary syndrome diagnosis in the emergency department
  1. Sandrine Charpentier1,2,
  2. Maxime Cournot2,3,
  3. Dominique Lauque1,
  4. Claire Girardi4,
  5. Vincent Bounes4,
  6. Meyer Elbaz5,
  7. Jean Louis Ducassé4
  1. 1Department of Emergency, Purpan University Hospital, Toulouse, France
  2. 2INSERM 558, Toulouse University, France
  3. 3Department of Epidemiology, Val d'Ariège Hospital, Foix, France
  4. 4Service d'Aide Médicale Urgente, Toulouse University Hospital, Toulouse, France
  5. 5Department of Cardiology, Rangueil University Hospital, Toulouse, France
  1. Correspondence to Sandrine Charpentier, Emergency Department, Purpan University Hospital, TSA 40031 Toulouse Cedex 9, France; charpentier.s{at}chu-toulouse.fr

Abstract

Introduction The aim of the study was to analyse the incremental usefulness of high blood glucose level for non-ST elevation acute coronary syndrome (ACS) diagnosis in patients admitted to the emergency department (ED) for chest pain and suspected ACS.

Methods A post hoc analysis of a prospective, observational study of 11 months duration was carried out. Initial glucose levels were analysed in 672 consecutive patients admitted to the ED with chest pain and suspected non-ST elevation ACS. A cut-off glucose level (>140 mg/dl) for high glucose level diagnosis was defined. Based on hospital diagnostic test results, patients were classified as having non-ST elevation ACS by two independent physicians. The association and performance of high glucose level for ACS diagnosis were studied by univariate and multivariate analysis and receiver operator characteristic (ROC) curves.

Results Out of the 672 eligible patients who were recruited, 181 (26.9%) had a confirmed non-ST elevation ACS. The independent factors associated with a diagnosis of ACS were age, previous coronary artery disease, hyperlipidaemia, smoking status and glucose level >140 mg/dl (OR 1.98 95% CI 1.14 to 3.45). In addition to a predictive model that included the usual diagnostic tools for non-ST elevation ACS management, a glucose level >140 mg/dl added significant incremental information (p=0.03). However, the addition of blood glucose level >140 mg/dl to the conventional diagnostic tool resulted in small increases in the ability to classify ACS, as measured by the c-statistic (0.82, 95% CI 0.79 to 0.85).

Conclusion An initial serum glucose level >140 mg/dl is associated with non-ST elevation ACS in patients admitted to an ED for chest pain but added moderately to conventional tools used for ACS diagnosis.

Clinical trial number NCT00714298.

  • Acute coronary syndrome
  • glucose level
  • diagnosis
  • acute myocardial infarct
  • cardiac care
  • nursing
  • emergency departments

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Footnotes

  • Funding This work was supported by a grant from the Clinical Research Hospital Program from the French Ministry of Health (PHRC 2005). This work was sponsored by the University Hospital of Toulouse for regulatory and ethic submission (No. 02 016 01).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the ethics committee of Toulouse University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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